Provider Demographics
NPI:1588955496
Name:HALL, MARY WALKER (RD)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:WALKER
Last Name:HALL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:WALKER
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 HATFIELD DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-5383
Mailing Address - Country:US
Mailing Address - Phone:615-589-6279
Mailing Address - Fax:
Practice Address - Street 1:4321 CAROTHERS PKWY
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5909
Practice Address - Country:US
Practice Address - Phone:615-435-5564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1018168133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered