MEDICARE: DR. MICHAEL E HALL JR. DMD, M.S.

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	390200000X	Student in an Organized Health Care Education/Training Program		GA
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN015692	GA

General Provider Information

NPI Number	:	1972008530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL E HALL JR. DMD, M.S.

Provider Business Mailing Address
First Line	:	121 MARBLE MILL RD NW STE 203
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-7959
Country	:	US
Telephone Number	:	404-542-9487
Fax Number	:

Provider Business Practice Location Address
First Line	:	121 MARBLE MILL RD NW STE 203
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-7959
Country	:	US
Telephone Number	:	404-542-9487
Fax Number	:

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

Provider Enumeration Date	:	03/27/2018
Last Update Date	:	07/27/2022

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