Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 18905 | MS |
NPI | 1003036252 |
---|---|
Provider Name | Dr. Tesia Shani Hall-Hill |
First Address | Jackson, MS 39213-4454 |
Second Address | Jackson, MS 39204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2007 |
Last Update Date | 04/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00937242 | (05) | MS |
I37668 | (02) | MS |