MEDICARE: KIMBERLY J HALL NP

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	207V00000X	Obstetrics & Gynecology Physician	RN101791	GA

General Provider Information

NPI Number	:	1720647464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY J HALL NP

Provider Business Mailing Address
First Line	:	1604 12TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-2938
Country	:	US
Telephone Number	:	706-324-0471
Fax Number	:	706-324-0473

Provider Business Practice Location Address
First Line	:	1604 12TH ST
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31906-2938
Country	:	US
Telephone Number	:	706-324-0471
Fax Number	:	706-324-0473

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

Provider Enumeration Date	:	06/06/2019
Last Update Date	:	06/25/2019

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