=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801918750
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HALL COUNTY BOARD OF HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2007
-----------------------------------------------------
Last Update Date | 07/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1290 ATHENS STREET
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-531-4085
-----------------------------------------------------
Fax | 770-535-5749
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1280 ATHENS STREET
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-531-5867
-----------------------------------------------------
Fax | 770-535-5958
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO HALL COUNTY BOARD OF HEALTH
-----------------------------------------------------
Name | DAVID WESTFALL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 770-535-5743
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | RN030957
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------