Healthcare Provider Details

I. General information

NPI: 1104023498
Provider Name (Legal Business Name): CHRISTOPHER MARK HALL PA - C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3686 WHEELER RD
AUGUSTA GA
30909-6520
US

IV. Provider business mailing address

3686 WHEELER RD
AUGUSTA GA
30909-6520
US

V. Phone/Fax

Practice location:
  • Phone: 706-922-6300
  • Fax: 706-922-6303
Mailing address:
  • Phone: 706-922-6300
  • Fax: 706-922-6303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1550
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1550
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: