Healthcare Provider Details

I. General information

NPI: 1982081766
Provider Name (Legal Business Name): JOHN DANIEL HALES III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 RIVERVIEW ST
FRANKLIN NC
28734
US

IV. Provider business mailing address

190 RIVERVIEW ST
FRANKLIN NC
28734-2658
US

V. Phone/Fax

Practice location:
  • Phone: 828-349-8260
  • Fax: 828-253-1123
Mailing address:
  • Phone: 828-349-8260
  • Fax: 828-253-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2018-01079
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2018-01079
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: