Healthcare Provider Details

I. General information

NPI: 1902885494
Provider Name (Legal Business Name): REGINALD VINSON HALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NORTHSIDE FORSYTH DR STE 250
CUMMING GA
30041-7701
US

IV. Provider business mailing address

35 COLLIER RD NW SUITE 635
ATLANTA GA
30309-1613
US

V. Phone/Fax

Practice location:
  • Phone: 770-889-7118
  • Fax: 770-844-7835
Mailing address:
  • Phone: 404-367-3014
  • Fax: 404-367-3558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number050478
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: