Provider Demographics
NPI:1538814421
Name:HALL, JORDAN O (MAT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:O
Last Name:HALL
Suffix:
Gender:F
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:O'NEAL
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MAT, LAT, ATC
Mailing Address - Street 1:PO BOX 1495
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:AL
Mailing Address - Zip Code:35470-1495
Mailing Address - Country:US
Mailing Address - Phone:251-422-7884
Mailing Address - Fax:
Practice Address - Street 1:UWA STATION 14
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:AL
Practice Address - Zip Code:35470
Practice Address - Country:US
Practice Address - Phone:251-422-7884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program