Individual
DR. KENNETH BRADLEY HALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1360 CADUCEUS WAY, BLDG 900 STE 101, WATKINSVILLE, GA 30677-7300
(706) 543-3629
(706) 543-5107
Mailing address
1360 CADUCEUS WAY, BLDG 900 STE 101, WATKINSVILLE, GA 30677-7300
(706) 543-3629
(706) 543-5107
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN012753
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
399593491A
—
GA
05
—
ZG2753
—
SC
Enumeration date
06/02/2006
Last updated
12/13/2016
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