Healthcare Provider Details

I. General information

NPI: 1114280591
Provider Name (Legal Business Name): RASHEEDA CROWELL HALL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2012
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W FREEDOM DR
LIBERTY MS
39645-7295
US

IV. Provider business mailing address

PO BOX 1729
HATTIESBURG MS
39403-1729
US

V. Phone/Fax

Practice location:
  • Phone: 601-657-8091
  • Fax: 833-314-0337
Mailing address:
  • Phone: 601-545-8700
  • Fax: 601-450-0794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24033
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: