Basic Information
| Provider Information | |||||||||
| NPI: | 1023110392 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOE I HALL MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 689 | ||||||||
| Address2: | |||||||||
| City: | WAYNESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384850689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317222800 | ||||||||
| FaxNumber: | 9317229627 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 J V MANGUBAT DRIVE | ||||||||
| Address2: | |||||||||
| City: | WAYNESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384852440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317222800 | ||||||||
| FaxNumber: | 9317229627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2006 | ||||||||
| LastUpdateDate: | 05/17/2019 | ||||||||
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| AuthorizedOfficialLastName: | BARBER | ||||||||
| AuthorizedOfficialFirstName: | SHERRI | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 9317222800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25882 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4060796 | 01 | TN | BCBS OF TN | OTHER | 3717844 | 05 | TN | MEDICAID |