Basic Information
Provider Information | |||||||||
NPI: | 1336437359 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HALL | ||||||||
FirstName: | JAMES | ||||||||
MiddleName: | KEVIN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8060 WOLF RIVER BLVD | ||||||||
Address2: |   | ||||||||
City: | GERMANTOWN | ||||||||
State: | TN | ||||||||
PostalCode: | 381381727 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 0127110009 | ||||||||
FaxNumber: | 9012714187 | ||||||||
Practice Location | |||||||||
Address1: | 100 BAPTIST MEMORIAL CIR STE 201 | ||||||||
Address2: |   | ||||||||
City: | OXFORD | ||||||||
State: | MS | ||||||||
PostalCode: | 38655 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9012711000 | ||||||||
FaxNumber: | 9012714187 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/11/2011 | ||||||||
LastUpdateDate: | 07/08/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 125060477 | IL | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | 23205 | MS | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   | 207RI0011X | 23205 | MS | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
ID | Type | State | Issuer | Description | FH8450063 | 01 | MS | DEA | OTHER |