Healthcare Provider Details

I. General information

NPI: 1275330276
Provider Name (Legal Business Name): ERIC HALL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8217 CREEKLINE CT
RIVERDALE GA
30274-4336
US

IV. Provider business mailing address

8217 CREEKLINE CT
RIVERDALE GA
30274-4336
US

V. Phone/Fax

Practice location:
  • Phone: 404-644-1283
  • Fax:
Mailing address:
  • Phone: 404-644-1283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225XR0403X
TaxonomyDriving and Community Mobility Occupational Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2278P4000X
TaxonomyPatient Transport Certified Respiratory Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2279P4000X
TaxonomyPatient Transport Registered Respiratory Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: