=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962676601
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN E HALL, JR., D.D.S., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/14/2008
-----------------------------------------------------
Last Update Date | 04/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1099 M L K JR DR NW
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30314-2943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-753-9742
-----------------------------------------------------
Fax | 404-753-9743
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1099 M L K JR DR NW
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30314-2943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-753-9742
-----------------------------------------------------
Fax | 404-753-9743
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FINANCIAL COORDINATOR
-----------------------------------------------------
Name | MRS. SONYA W WATKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 404-753-9742
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 9735
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------