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General NPI Number Information
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NPI Number | 1093785578
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Entity Type | Individual
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Provider Name | RONALD DAKER HALL III MD
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Gender | Male
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Dates
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Enumeration Date | 01/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 919 EAST CENTRAL AVENUE SUITE 101B
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City | LAFOLLETTE
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State | TN
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Zip | 37766-2778
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Country | US
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Telephone | 423-562-6586
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Fax | 423-566-4559
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Provider Business Mailing Address
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Address Line | 919 EAST CENTRAL AVENUE SUITE 101B
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City | LAFOLLETTE
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State | TN
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Zip | 37766-2778
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Country | US
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Telephone | 423-562-6586
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Fax | 423-566-4559
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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 | 7132
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License Number State | TN
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