Healthcare Provider Details

I. General information

NPI: 1003036252
Provider Name (Legal Business Name): TESIA SHANI HALL-HILL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 05/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5429 ROBINSON ROAD EXT
JACKSON MS
39204
US

IV. Provider business mailing address

3502 W NORTHSIDE DR
JACKSON MS
39213-4454
US

V. Phone/Fax

Practice location:
  • Phone: 601-914-0163
  • Fax: 601-914-0170
Mailing address:
  • Phone: 601-362-5321
  • Fax: 601-364-5159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18905
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: