Provider Demographics
NPI:1871518597
Name:HALL, JAMES BERNARD (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BERNARD
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:747 INDUSTRIAL PARK ROAD NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-8064
Mailing Address - Country:US
Mailing Address - Phone:601-833-4111
Mailing Address - Fax:601-833-1444
Practice Address - Street 1:747 INDUSTRIAL PARK RD NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2065
Practice Address - Country:US
Practice Address - Phone:601-833-4111
Practice Address - Fax:601-833-1444
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18365207R00000X, 208M00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09923554Medicaid
MS302I935314Medicare PIN