Healthcare Provider Details

I. General information

NPI: 1265832554
Provider Name (Legal Business Name): CARRIE VIRGINIA HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 MCDOWELL ST STE 1
ASHEVILLE NC
28801-4435
US

IV. Provider business mailing address

PO BOX 100181
COLUMBIA SC
29202-3141
US

V. Phone/Fax

Practice location:
  • Phone: 828-407-4581
  • Fax:
Mailing address:
  • Phone: 828-202-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-09302
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-09302
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number007268
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: