Basic Information
| Provider Information | |||||||||
| NPI: | 1083173769 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | RAY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4030 WAKE FOREST RD STE 349 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276090010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5097682249 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2053 VALLEYGATE DR STE 102 | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283043983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103233757 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2019 | ||||||||
| LastUpdateDate: | 10/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 296959 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.