Provider Demographics
NPI:1902885494
Name:HALL, REGINALD VINSON (MD)
Entity Type:Individual
Prefix:DR
First Name:REGINALD
Middle Name:VINSON
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:35 COLLIER RD NW
Mailing Address - Street 2:SUITE 635
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1613
Mailing Address - Country:US
Mailing Address - Phone:404-367-3014
Mailing Address - Fax:404-367-3558
Practice Address - Street 1:1400 NORTHSIDE FORSYTH DR STE 250
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7701
Practice Address - Country:US
Practice Address - Phone:770-889-7118
Practice Address - Fax:770-844-7835
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2018-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0504782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52864345OtherBLUE CROSS & BLUE SHIELD
GA000920796CMedicaid
7357225OtherAETNA
GA6941783OtherCIGNA HEALTH CARE
13BDDKV01Medicare PIN
13BDDKVOtherMEDICARE ID
130024279OtherR X R MEDICARE
GAH43278Medicare UPIN
GABH7385328OtherDEA
GA009981360OtherALABAMA MEDICAID
GA000920796BMedicaid
GA000920796AMedicaid
GA130024279OtherRAIL ROAD MEDICARE
GA2157852OtherUNITED HEALTH CARE