Provider Demographics
NPI:1659107225
Name:HALL, AUSTIN B (PA-C)
Entity type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:B
Last Name:HALL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12749 BROOKS MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:MI
Mailing Address - Zip Code:49230-9138
Mailing Address - Country:US
Mailing Address - Phone:517-499-2700
Mailing Address - Fax:
Practice Address - Street 1:12749 BROOKS MEADOW DR
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:MI
Practice Address - Zip Code:49230-9138
Practice Address - Country:US
Practice Address - Phone:517-499-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant