Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 19416 | SC |
NPI | 1003203811 |
---|---|
Provider Name | Richard Hall III |
First Address | Sumter, SC 29150 |
Second Address | Sumter, SC 29150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2015 |
Last Update Date | 24/10/2018 |