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General NPI Number Information
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NPI Number | 1871976522
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Entity Type | Organization
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Legal Business Name | HALL SURGICAL ASSISTANCE, LLC
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Dates
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Enumeration Date | 06/30/2015
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Last Update Date | 09/02/2016
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Provider Practice Location Address
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Address Line | 10332 MAIN ST SUITE #344
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City | FAIRFAX
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State | VA
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Zip | 22030-2410
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Country | US
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Telephone | 703-798-5924
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Fax | 301-782-9929
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Provider Business Mailing Address
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Address Line | PO BOX 15607
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City | ARLINGTON
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State | VA
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Zip | 22215-0607
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Country | US
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Telephone | 571-309-9768
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Fax | 888-356-1032
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Authorized Official
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Title or Position | CEO
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Name | MR. DALTON MONZELLROE HALL JR.
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Credential | SA-C
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Telephone | 703-798-5924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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