Healthcare Provider Details

I. General information

NPI: 1629073705
Provider Name (Legal Business Name): AUBREY C HALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JACKSON RIVER INTERNIST 1 ARH LANE, STE. 300
LOW MOOR VA
24457
US

IV. Provider business mailing address

PO BOX 457
WHITE SULPHUR SPRINGS WV
24986-0457
US

V. Phone/Fax

Practice location:
  • Phone: 540-862-6710
  • Fax: 540-862-5727
Mailing address:
  • Phone: 304-536-5030
  • Fax: 304-536-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101017938
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: