# JACQUELYN HALL-DAVIS,M.D. LTD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699173542
- **Authorized official:** DR. JACQUELYN HALL-DAVIS M.D. (PRESIDENT)
- **Authorized official phone:** (618) 622-9240

## Contact information

- **Practice address:** 1669 WINDHAM WAY, SUITE B, O FALLON, IL 62269-3072
- **Practice address phone:** (618) 622-9240
- **Practice address fax:** (618) 622-9241
- **Mailing address:** 1669 WINDHAM WAY, SUITE B, O FALLON, IL 62269-3072
- **Mailing address phone:** (618) 622-9240
- **Mailing address fax:** (618) 622-9241

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0804X | Child & Adolescent Psychiatry Physician | 036080270 | IL | Yes |

## Other

- **Enumeration date:** 12/09/2014
- **Last updated:** 12/09/2014