Individual provider Active NPI

Jacqueline Alford Hall, FNP-C

  • Family Nurse Practitioner
  • Griffin, GA
National Provider Identifier
1376104802
Registry record updated Sep 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN233311 Issued in GA
Practice address
822 S Hill St
Griffin, GA 30224-4842
Phone
(229) 273-8881
Fax
(229) 273-8985
NPI assigned
Jun 25, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN233311 GA
Family Nurse Practitioner 363LF0000X RN233311 GA Primary

Addresses

Primary practice location

822 S Hill St
Griffin, GA 30224-4842

Mailing address

PO Box 5610
Cordele, GA 31010
Phone (229) 273-8881

Other names 1

  • Jacqueline Sarah Hall Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191104001350 GA Practitioner - Nurse Practitioner 8123350535 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Peachtree Immediate Care FP, LLCGroup PAC ID 3274559323, 328 clinicians

Practice addresses (Care Compare)

371 Newnan Crossing Byp
Suite 103
Newnan, GA 30265-3888
Phone (770) 400-8410

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN233311GAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Peachtree Immediate Care FP, LLC CurrentSince Dec 28, 2022 Accepting new patients
Careconnect Health, Inc. CurrentSince Sep 26, 2019 Accepting new patients
Careconnect Health, Inc. CurrentSince Sep 26, 2019 Accepting new patients

Locations

590 Lanier Ave W
Fayetteville, GA 30214

822 S Hill St
Griffin, GA 30224
Phone (770) 228-1181

3827 Jimmy Lee Smith Pkwy
Hiram, GA 30141
Phone (770) 222-8900

371 Newnan Crossing Byp
Ste 103
Newnan, GA 30265
Phone (770) 400-8410

510 Alston St
Ste B
Richland, GA 31825
Phone (229) 887-3324

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1561420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569456000000",
    "number": "1376104802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5610",
            "city": "CORDELE",
            "state": "GA",
            "postal_code": "31010",
            "telephone_number": "229-273-8881",
            "fax_number": "229-273-8985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "822 S HILL ST",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302244842",
            "telephone_number": "229-273-8881",
            "fax_number": "229-273-8985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALL",
        "first_name": "JACQUELINE",
        "middle_name": "ALFORD",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-25",
        "last_updated": "2019-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN233311",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN233311",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "HALL",
            "middle_name": "SARAH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Griffin, GA

Sources for this page

Verify at the official NPI Registry.