Individual
DR. EDWARD L HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 MIMOSA DRIVE, THOMASVILLE, GA 31792
(229) 226-8881
(229) 225-2165
Mailing address
100 MIMOSA DRIVE, THOMASVILLE, GA 31792
(229) 226-8881
(229) 225-2165
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
020724
GA
208600000X
Surgery Physician
Primary
020724
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000264129B
PEACH STATE
GA
05
—
000264129B
—
GA
05
—
000264129I
—
GA
01
—
110153551
RAILROAD MEDICARE
GA
01
—
207430
WELLCARE
GA
Enumeration date
01/17/2006
Last updated
09/17/2020
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