Healthcare Provider Details

I. General information

NPI: 1295798429
Provider Name (Legal Business Name): LANCE T HALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 06/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE
ATLANTA GA
30322
US

IV. Provider business mailing address

1364 CLIFTON RD NE
ATLANTA GA
30322-1059
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-4747
  • Fax: 404-686-5709
Mailing address:
  • Phone: 404-778-4747
  • Fax: 404-686-5709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number82802
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number47126
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: