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General NPI Number Information
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NPI Number | 1285241265
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Entity Type | Individual
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Provider Name | JENNIFER ANN HALES NP-C #F05200177
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Gender | Female
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Dates
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Enumeration Date | 09/24/2020
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Last Update Date | 11/10/2020
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Provider Practice Location Address
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Address Line | 11909 MCAULEY DR STE 1002A
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City | SAVANNAH
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State | GA
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Zip | 31419-1793
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Country | US
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Telephone | 912-354-8331
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Fax |
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Provider Business Mailing Address
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Address Line | 836 E 65TH ST STE 22
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City | SAVANNAH
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State | GA
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Zip | 31405-4493
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Country | US
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Telephone | 912-414-6034
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Fax |
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | RN196020
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN196020
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License Number State | GA
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