MEDICARE: DR. KEISHA NICOLE DENNARD-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	174400000X	Specialist	058877	GA
2	207V00000X	Obstetrics & Gynecology Physician	058877	GA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497723985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEISHA NICOLE DENNARD-HALL MD

Provider Business Mailing Address
First Line	:	5780 PEACHTREE DUNWOODY ROAD
Second Line	:	SUITE 300
City	:	ATLANTA
State	:	GA
Zip	:	30342-1513
Country	:	US
Telephone Number	:	404-303-1224
Fax Number	:	404-303-1325

Provider Business Practice Location Address
First Line	:	3890 JOHNS CREEK PKWY
Second Line	:	SUITE 300
City	:	SUWANEE
State	:	GA
Zip	:	30024-1284
Country	:	US
Telephone Number	:	678-775-2300
Fax Number	:	678-775-2359

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	08/08/2013

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Directions to “ DR. KEISHA NICOLE DENNARD-HALL MD” Practice Location

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