Provider Demographics
NPI:1710787478
Name:HALL, ALICIA (AGAC-NP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:HALL
Suffix:
Gender:
Credentials:AGAC-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 PINE ST STE 750
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-7528
Mailing Address - Country:US
Mailing Address - Phone:478-633-1458
Mailing Address - Fax:478-633-5025
Practice Address - Street 1:840 PINE ST STE 750
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7528
Practice Address - Country:US
Practice Address - Phone:478-633-1458
Practice Address - Fax:478-633-5025
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN275132363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care