Provider Demographics
NPI:1528141850
Name:HALL, JENNY LIND (DPM)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:LIND
Last Name:HALL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:207 LEE ST
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-3821
Mailing Address - Country:US
Mailing Address - Phone:919-734-8007
Mailing Address - Fax:919-736-4048
Practice Address - Street 1:207 LEE ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-3821
Practice Address - Country:US
Practice Address - Phone:919-734-8007
Practice Address - Fax:919-736-4048
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC221213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE08067OtherSTATE OF NC
NC561802185OtherTRICARE
NC08067OtherBLUE CROSS BLUE SHIELD
NC1689706905OtherFACILITY NPI # WAYNE FOOT SPECIALISTS
NC8908067Medicaid
NC480019991OtherMEDICARE RAILROAD
NCT64085Medicare UPIN
NC5894610001Medicare NSC
NC8908067Medicaid