Healthcare Provider Details

I. General information

NPI: 1922355239
Provider Name (Legal Business Name): TINA MARIE HALE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 OGLETHORPE AVE SUITE 2000
ATHENS GA
30606-2179
US

IV. Provider business mailing address

1500 OGLETHORPE AVE SUITE 2000
ATHENS GA
30606-2179
US

V. Phone/Fax

Practice location:
  • Phone: 706-543-6261
  • Fax: 706-543-7060
Mailing address:
  • Phone: 706-543-6261
  • Fax: 706-543-7060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN086905
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: