Healthcare Provider Details

I. General information

NPI: 1376104802
Provider Name (Legal Business Name): JACQUELINE ALFORD HALL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACQUELINE SARAH HALL

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 S HILL ST
GRIFFIN GA
30224-4842
US

IV. Provider business mailing address

PO BOX 5610
CORDELE GA
31010
US

V. Phone/Fax

Practice location:
  • Phone: 229-273-8881
  • Fax: 229-273-8985
Mailing address:
  • Phone: 229-273-8881
  • Fax: 229-273-8985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN233311
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN233311
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: