Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | M4498 | TX |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 077377 | GA |
NPI | 1326129644 |
---|---|
Provider Name | Nicole Ruddock Hall |
First Address | Atlanta, GA 30342-1606 |
Second Address | Atlanta, GA 30342-1606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2006 |
Last Update Date | 21/07/2017 |