Provider Demographics
NPI:1992934657
Name:HALL, ROY
Entity type:Individual
Prefix:MR
First Name:ROY
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 SADDLE LAKE DR
Mailing Address - Street 2:859 SADDLE LAKE DR
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-3226
Mailing Address - Country:US
Mailing Address - Phone:770-498-8644
Mailing Address - Fax:
Practice Address - Street 1:859 SHADOW LAKE DR
Practice Address - Street 2:STE 100
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-3226
Practice Address - Country:US
Practice Address - Phone:770-498-8644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider