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1114998267

NPI Code Detail

MEDICARE: JOHN DAVID HALL MD

MEDICARE: JOHN DAVID HALL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	200500309	NC
2	2084P0802X	Addiction Psychiatry Physician	200500309	NC
3	2084P0015X	Psychosomatic Medicine Physician	200500309	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114998267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN DAVID HALL MD

Provider Business Mailing Address
First Line	:	5567 YORKE ST NW
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28027-5333
Country	:	US
Telephone Number	:	704-796-4009
Fax Number	:

Provider Business Practice Location Address
First Line	:	6809 FAIRVIEW RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-3336
Country	:	US
Telephone Number	:	704-796-4009
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	10/02/2008

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Directions to “ JOHN DAVID HALL MD” Practice Location

Language	Start Address	Practice Location

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