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General NPI Number Information
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NPI Number | 1760986384
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Entity Type | Individual
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Provider Name | KRISHAYLA HALL
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Gender | Female
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 03/19/2018
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Provider Practice Location Address
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Address Line | 1824 WYLDS RD STE B1
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City | AUGUSTA
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State | GA
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Zip | 30909-5423
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Country | US
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Telephone | 706-922-6310
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Fax |
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Provider Business Mailing Address
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Address Line | 3194 LEXINGTON WAY
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City | AUGUSTA
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State | GA
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Zip | 30909-9231
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Country | US
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Telephone | 706-627-1916
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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 | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number | 051709978
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License Number State | GA
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