Healthcare Provider Details

I. General information

NPI: 1649149154
Provider Name (Legal Business Name): ALEX HALL DHSC
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 JESSE HILL JR DR SE STE 126
ATLANTA GA
30303-3049
US

IV. Provider business mailing address

49 JESSE HILL JR DR SE STE 126
ATLANTA GA
30303-3049
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-1585
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP10134
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN215383
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License NumberRN215383
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN215383
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: