Provider Demographics
NPI:1548669161
Name:HALL, VERNON LANIER (RPA,RA RT(R))
Entity type:Individual
Prefix:
First Name:VERNON
Middle Name:LANIER
Last Name:HALL
Suffix:
Gender:M
Credentials:RPA,RA RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3529 COLUMBIA PKWY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-3321
Mailing Address - Country:US
Mailing Address - Phone:404-343-1113
Mailing Address - Fax:
Practice Address - Street 1:3529 COLUMBIA PKWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-3321
Practice Address - Country:US
Practice Address - Phone:404-343-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT07GA1282243U00000X
GA2137582471V0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant
No2471V0106XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular-Interventional Technology