Provider Demographics
NPI:1902938004
Name:HALL, CHARLES DAVID (CRNA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:DAVID
Last Name:HALL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3559
Mailing Address - Country:US
Mailing Address - Phone:770-387-0544
Mailing Address - Fax:770-387-0543
Practice Address - Street 1:960 JOE FRANK HARRIS PKWY SE
Practice Address - Street 2:ANESTHESIA DEPT
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2129
Practice Address - Country:US
Practice Address - Phone:770-382-1530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN154037367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP180OtherMEDICARE GROUP NUMBER
GA00963498AMedicaid
GA43ZCBNG12Medicare ID - Type Unspecified