Provider Demographics
NPI:1194938563
Name:HALL, CYNTHIA P (DMD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:P
Last Name:HALL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 CLEAR CREEK VALLEY TRL
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30536-7975
Mailing Address - Country:US
Mailing Address - Phone:706-276-4685
Mailing Address - Fax:
Practice Address - Street 1:160 SAILORS DR
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-3743
Practice Address - Country:US
Practice Address - Phone:706-276-2828
Practice Address - Fax:706-276-2826
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0115461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA12088OtherAVESIS
GA9180288OtherSCION
GA001347148OtherUNITED CONCORDIA
GA00912678AMedicaid