Provider Demographics
NPI:1043856412
Name:HALL, MALAYSHA DEASHA
Entity type:Individual
Prefix:MS
First Name:MALAYSHA
Middle Name:DEASHA
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7002 HODGSON MEMORIAL DR STE 109
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-1517
Mailing Address - Country:US
Mailing Address - Phone:912-438-6897
Mailing Address - Fax:
Practice Address - Street 1:7002 HODGSON MEMORIAL DR STE 109
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-1517
Practice Address - Country:US
Practice Address - Phone:912-438-6897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACAF20150018374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty