Organization
JACQUELYN HALL-DAVIS,M.D. LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACQUELYN HALL-DAVIS M.D. (PRESIDENT)
(618) 622-9240
Entity
Organization
Contact information
Practice address
1669 WINDHAM WAY, SUITE B, O FALLON, IL 62269-3072
(618) 622-9240
(618) 622-9241
Mailing address
1669 WINDHAM WAY, SUITE B, O FALLON, IL 62269-3072
(618) 622-9240
(618) 622-9241
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
036080270
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036080270
—
IL
01
—
540653
TRICARE
IL
Enumeration date
12/09/2014
Last updated
12/09/2014
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