Healthcare Provider Details

I. General information

NPI: 1003078296
Provider Name (Legal Business Name): CARZADEAN BERNADETTE HALL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2008
Last Update Date: 06/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 FRANKLIN FARMS CIR
FAYETTEVILLE GA
30214-3361
US

IV. Provider business mailing address

185 FRANKLIN FARMS CIR
FAYETTEVILLE GA
30214-3361
US

V. Phone/Fax

Practice location:
  • Phone: 404-216-0132
  • Fax:
Mailing address:
  • Phone: 404-216-0132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number034309
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: