Healthcare Provider Details

I. General information

NPI: 1134407075
Provider Name (Legal Business Name): ROBERT A HALL MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 07/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 LONGFIELD CT
SAVANNAH GA
31410-3513
US

IV. Provider business mailing address

10 LONGFIELD CT
SAVANNAH GA
31410-3513
US

V. Phone/Fax

Practice location:
  • Phone: 912-656-2596
  • Fax: 912-356-6970
Mailing address:
  • Phone: 912-656-2596
  • Fax: 912-356-6970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number64818
License Number StateGA

VIII. Authorized Official

Name: MR. WILLIAM RONNING
Title or Position: ATTORNEY
Credential: JD
Phone: 912-355-8188