MEDICARE: GEORGE D 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	311ZA0620X	Adult Care Home Facility	38350	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	:	1861425290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE D HALL, MD

Provider Business Mailing Address
First Line	:	2415 SANDY PORTER RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28273-3695
Country	:	US
Telephone Number	:	704-540-2799
Fax Number	:	704-583-0430

Provider Business Practice Location Address
First Line	:	3111 SPRINGBANK LN
Second Line	:	SUITE I
City	:	CHARLOTTE
State	:	NC
Zip	:	28226-3372
Country	:	US
Telephone Number	:	704-540-2799
Fax Number	:	704-847-6858

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	GEORGE D HALL
Credential	:	M.D.
Telephone Number	:	704-540-2799

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	11/27/2007

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