Healthcare Provider Details

I. General information

NPI: 1831209147
Provider Name (Legal Business Name): R ALAN HALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 E 63RD ST
SAVANNAH GA
31405-4420
US

IV. Provider business mailing address

PO BOX 30053
SAVANNAH GA
31410-0053
US

V. Phone/Fax

Practice location:
  • Phone: 912-355-8188
  • Fax: 912-356-6970
Mailing address:
  • Phone: 912-355-8188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number64818
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD00031994
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: