# IEP OBSERVATION MEDICINE - JACKSON PLLC

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

## Provider details

- **NPI number:** 1982478251
- **Authorized official:** DR. DAVID GERALD HALL MD (MANAGER)
- **Authorized official phone:** (248) 536-2127

## Contact information

- **Practice address:** 205 N EAST AVE, JACKSON, MI 49201-1753
- **Practice address phone:** (248) 536-2127
- **Practice address fax:** (248) 893-6952
- **Mailing address:** PO BOX 675472, DETROIT, MI 48267-5472
- **Mailing address phone:** (248) 536-2127
- **Mailing address fax:** (248) 893-6952

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | — | NULL | Yes |
| 207PE0004X | Emergency Medical Services (Emergency Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/08/2023
- **Last updated:** 05/08/2025