Basic Information
| Provider Information | |||||||||
| NPI: | 1831209147 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | R | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 30053 | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314100053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123558188 | ||||||||
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| Practice Location | |||||||||
| Address1: | 815 E 63RD ST | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314054420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123558188 | ||||||||
| FaxNumber: | 9123566970 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 06/15/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | MD00031994 | WA | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 207Q00000X | 64818 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 780001652 | 01 | RAILROAD MEDICARE | OTHER | MD5703W | 01 | WA | ALASKA MEDICAID | OTHER | 8169419 | 05 | WA | MEDICAID | 0030021 | 01 | WA | LABOR & INDUSTRY | OTHER | US0862357 | 01 | WA | AETNA/USHC SPECIALIST | OTHER | HA0297 | 01 | WA | BLUE SHIELD | OTHER |