Healthcare Provider Details

I. General information

NPI: 1104388982
Provider Name (Legal Business Name): HUNTER CARROLL HALL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 GRAMMONT ST
MONROE LA
71201-7516
US

IV. Provider business mailing address

611 GRAMMONT ST
MONROE LA
71201-7516
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-2634
  • Fax:
Mailing address:
  • Phone: 318-325-2634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number330721
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number330721
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: