MEDICARE: PEARL MEDICAL & ASSOCIATES, LLC

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	261QP2300X	Primary Care Clinic/Center	052946	GA

General Provider Information

NPI Number	:	1871752410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEARL MEDICAL & ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	2550 WINDY HILL RD SE STE 109
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-8607
Country	:	US
Telephone Number	:	770-952-7477
Fax Number	:

Provider Business Practice Location Address
First Line	:	2550 WINDY HILL RD SE STE 109
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-8607
Country	:	US
Telephone Number	:	770-952-7477
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PEDIATRICIAN
Name	:	DR. ANGELA M. HALL
Credential	:	M.D.
Telephone Number	:	770-952-7477

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	06/09/2008

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