Healthcare Provider Details

I. General information

NPI: 1023110392
Provider Name (Legal Business Name): JOE I HALL MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 J V MANGUBAT DRIVE
WAYNESBORO TN
38485-2440
US

IV. Provider business mailing address

PO BOX 689
WAYNESBORO TN
38485-0689
US

V. Phone/Fax

Practice location:
  • Phone: 931-722-2800
  • Fax: 931-722-9627
Mailing address:
  • Phone: 931-722-2800
  • Fax: 931-722-9627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25882
License Number StateTN

VIII. Authorized Official

Name: SHERRI L BARBER
Title or Position: CREDENTIALING
Credential:
Phone: 931-722-2800