Provider Demographics
NPI:1982768065
Name:HALL, MACY GIVINGS JR (FACS)
Entity type:Individual
Prefix:DR
First Name:MACY
Middle Name:GIVINGS
Last Name:HALL
Suffix:JR
Gender:M
Credentials:FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 GOLDEN OAK TER
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7746
Mailing Address - Country:US
Mailing Address - Phone:301-983-1009
Mailing Address - Fax:
Practice Address - Street 1:1140 VARNUM ST NE
Practice Address - Street 2:SUITE 103
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2151
Practice Address - Country:US
Practice Address - Phone:202-723-8768
Practice Address - Fax:202-529-8172
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD25515174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400680100Medicaid
DC023378500Medicaid
DC177972Medicare ID - Type Unspecified
DC023378500Medicaid