Healthcare Provider Details

I. General information

NPI: 1023061447
Provider Name (Legal Business Name): JOHN K HALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

6304 TIFFANY OAKS LN
ARLINGTON TX
76016-2034
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5900
  • Fax: 601-984-5939
Mailing address:
  • Phone: 214-810-0856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number21068
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberJ6988
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: