Provider Demographics
NPI:1447545975
Name:HALL, GEORGE ALBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ALBERT
Last Name:HALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 WHITECREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-3889
Mailing Address - Country:US
Mailing Address - Phone:865-983-4550
Mailing Address - Fax:865-983-4550
Practice Address - Street 1:315 WHITECREST DRIVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-3889
Practice Address - Country:US
Practice Address - Phone:865-983-4550
Practice Address - Fax:865-983-4550
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN16341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice