Provider Demographics
NPI:1437905585
Name:HALL, VIRGINIA FAY
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:FAY
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14143 HWY 242
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:GA
Mailing Address - Zip Code:30413-3201
Mailing Address - Country:US
Mailing Address - Phone:937-583-1082
Mailing Address - Fax:
Practice Address - Street 1:1234 S HARRIS ST
Practice Address - Street 2:
Practice Address - City:SANDERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31082-6912
Practice Address - Country:US
Practice Address - Phone:937-583-1082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)