Healthcare Provider Details

I. General information

NPI: 1568438521
Provider Name (Legal Business Name): ERIC LEE HALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 S MAIN ST STE A
HINESVILLE GA
31313-4344
US

IV. Provider business mailing address

512 S MAIN ST STE A
HINESVILLE GA
31313-4344
US

V. Phone/Fax

Practice location:
  • Phone: 912-369-5437
  • Fax: 912-369-5740
Mailing address:
  • Phone: 912-369-5437
  • Fax: 912-369-5740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number045814
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: