Healthcare Provider Details

I. General information

NPI: 1265428460
Provider Name (Legal Business Name): JAMES D HALL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 06/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BISHOP ST
UNION CITY TN
38261-5403
US

IV. Provider business mailing address

PO BOX 387
UNION CITY TN
38281-0387
US

V. Phone/Fax

Practice location:
  • Phone: 731-885-0787
  • Fax: 731-885-0756
Mailing address:
  • Phone: 731-885-0787
  • Fax: 731-885-0756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN38418
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: