Provider Demographics
NPI:1174610935
Name:HALL, JOHN H JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:HALL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1305 W WENDOVER AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408
Mailing Address - Country:US
Mailing Address - Phone:336-333-9111
Mailing Address - Fax:336-333-2042
Practice Address - Street 1:1305 W WENDOVER AVE
Practice Address - Street 2:SUITE D
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408
Practice Address - Country:US
Practice Address - Phone:336-333-9111
Practice Address - Fax:336-333-2042
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC35358207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC38371OtherBCBS
NC893837Medicaid
NC38371OtherBCBS
E74488Medicare UPIN