Provider Demographics
NPI:1023640067
Name:HALL, ROBERT TIMOTHY JR
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:TIMOTHY
Last Name:HALL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:HAWKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31036-8420
Mailing Address - Country:US
Mailing Address - Phone:478-783-0555
Mailing Address - Fax:478-783-0550
Practice Address - Street 1:153 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036-8420
Practice Address - Country:US
Practice Address - Phone:478-783-0555
Practice Address - Fax:478-783-0550
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH029188183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty