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General NPI Number Information
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NPI Number | 1659512267
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Entity Type | Individual
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Provider Name | DENNIS HALL O D
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Gender | Male
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Dates
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Enumeration Date | 03/11/2009
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Last Update Date | 03/11/2009
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Provider Practice Location Address
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Address Line | 1440 CUMBERLAND MALL SE
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City | ATLANTA
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State | GA
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Zip | 30339-3139
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Country | US
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Telephone | 770-434-9788
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Fax |
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Provider Business Mailing Address
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Address Line | 4005 HOLCOMB BRIDGE RD
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City | NORCROSS
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State | GA
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Zip | 30092-1838
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Country | US
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Telephone | 770-434-9788
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 02215
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License Number State | GA
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