Healthcare Provider Details

I. General information

NPI: 1114998267
Provider Name (Legal Business Name): JOHN DAVID HALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6809 FAIRVIEW RD
CHARLOTTE NC
28210-3336
US

IV. Provider business mailing address

5567 YORKE ST NW
CONCORD NC
28027-5333
US

V. Phone/Fax

Practice location:
  • Phone: 704-796-4009
  • Fax:
Mailing address:
  • Phone: 704-796-4009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number200500309
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number200500309
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number200500309
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: