Healthcare Provider Details

I. General information

NPI: 1922516244
Provider Name (Legal Business Name): EMMA HALL AG-ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2018
Last Update Date: 01/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 JESSE HILL JR DR SE RM 309A
ATLANTA GA
30303-3033
US

IV. Provider business mailing address

69 JESSE HILL JR DR SE RM 309A
ATLANTA GA
30303-3033
US

V. Phone/Fax

Practice location:
  • Phone: 404-251-8743
  • Fax: 404-523-3931
Mailing address:
  • Phone: 404-251-8743
  • Fax: 404-523-3931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN226430
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNCO-000003
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: