Healthcare Provider Details

I. General information

NPI: 1023772944
Provider Name (Legal Business Name): LIL MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 TUNNEL RD STE A
ASHEVILLE NC
28805-2065
US

IV. Provider business mailing address

PO BOX 9670
ASHEVILLE NC
28815-0670
US

V. Phone/Fax

Practice location:
  • Phone: 828-595-6548
  • Fax:
Mailing address:
  • Phone: 507-401-1465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN HALL
Title or Position: PHYSICIAN
Credential: MD
Phone: 507-401-1465