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General NPI Number Information
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NPI Number | 1003036252
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Entity Type | Individual
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Provider Name | TESIA SHANI HALL-HILL D.O.
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Gender | Female
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Dates
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Enumeration Date | 04/30/2007
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 5429 ROBINSON ROAD EXT
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City | JACKSON
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State | MS
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Zip | 39204
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Country | US
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Telephone | 601-914-0163
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Fax | 601-914-0170
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Provider Business Mailing Address
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Address Line | 3502 W NORTHSIDE DR
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City | JACKSON
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State | MS
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Zip | 39213-4454
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Country | US
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Telephone | 601-362-5321
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Fax | 601-364-5159
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 18905
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License Number State | MS
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