Healthcare Provider Details

I. General information

NPI: 1760986384
Provider Name (Legal Business Name): KRISHAYLA HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 WYLDS RD STE B1
AUGUSTA GA
30909-5423
US

IV. Provider business mailing address

3194 LEXINGTON WAY
AUGUSTA GA
30909-9231
US

V. Phone/Fax

Practice location:
  • Phone: 706-922-6310
  • Fax:
Mailing address:
  • Phone: 706-627-1916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number051709978
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: