Healthcare Provider Details

I. General information

NPI: 1780168203
Provider Name (Legal Business Name): BRIANA MANLEY-HALL PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANA HALL PMHNP

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 EASTWICK CT
MACON GA
31210-1094
US

IV. Provider business mailing address

PO BOX 5312
MACON GA
31208-5312
US

V. Phone/Fax

Practice location:
  • Phone: 478-370-1556
  • Fax: 888-807-3010
Mailing address:
  • Phone: 478-370-1556
  • Fax: 888-807-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5011172
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN204810
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: