Provider Demographics
NPI:1063522555
Name:HALL, GEORGE JEFFREY (PA)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:JEFFREY
Last Name:HALL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:G
Other - Middle Name:JEFFREY
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:1523 CHICKASHA DR
Mailing Address - Street 2:
Mailing Address - City:PFAFFTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27040-8203
Mailing Address - Country:US
Mailing Address - Phone:585-766-1135
Mailing Address - Fax:585-223-4984
Practice Address - Street 1:PHYSICIANS ELDERCARE
Practice Address - Street 2:4692 BROWNSBORO RD
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-2710
Practice Address - Country:US
Practice Address - Phone:336-251-1114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-09654363A00000X
NY005018363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP48059Medicare UPIN
NYDD0280Medicare ID - Type Unspecified