Healthcare Provider Details

I. General information

NPI: 1639688989
Provider Name (Legal Business Name): PAMELA HALL, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 S MAIN ST
MADISON GA
30650-2054
US

IV. Provider business mailing address

2002 S MAIN ST
MADISON GA
30650-2054
US

V. Phone/Fax

Practice location:
  • Phone: 706-438-1122
  • Fax: 706-438-4254
Mailing address:
  • Phone: 706-438-1122
  • Fax: 706-438-4254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number050886
License Number StateGA

VIII. Authorized Official

Name: DR. PAMELA G. HALL
Title or Position: PHYSICIAN
Credential: MD
Phone: 706-438-1122