Individual provider Active NPI

Anthony James Hall, APRN

  • Psychiatric/Mental Health Nurse Practitioner
  • Fayetteville, GA
National Provider Identifier
1558904169
Registry record updated May 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
RN200530 Issued in GA
Practice address
1415 Highway 85 N # 310302
Fayetteville, GA 30214-7738
Phone
(678) 551-7083
Fax
(678) 487-5367
NPI assigned
Oct 26, 2019
Last updated
May 13, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X RN200530 GA Primary

Addresses

Primary practice location

1415 Highway 85 N # 310302
Fayetteville, GA 30214-7738

Mailing address

1415 Highway 85 N # 310302
Fayetteville, GA 30214-7738
Phone (678) 551-7083

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
I20221127000031 GA Practitioner - Nurse Practitioner 9436564085 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1415 Hwy 85 N
Fayetteville, GA 30214-7738
Phone (678) 551-7083

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Esfahani Enterprises LLC CurrentSince Oct 1, 2022 Accepting new patients
Ascension Psychiatric Services LLC Psychiatric/Mental Health CurrentSince Apr 3, 2023 Accepting new patients
Personal Recovery Network LLC CurrentSince Feb 2, 2021 Accepting new patients
The Neuropsychiatric Clinic of Atlantis-Villa Rica, P.C. PastSince Nov 1, 2019 Accepting new patients

Locations

1415 Highway 85 N
Ste 310302
Fayetteville, GA 30214
Phone (678) 551-7083

250 Corporate Center Ct
Stockbridge, GA 30281
Phone (770) 954-8685

700 Churchill Ct
Ste 140
Woodstock, GA 30188
Phone (678) 384-4911

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1572048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652400000000",
    "number": "1558904169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 HIGHWAY 85 N # 310302",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147738",
            "telephone_number": "678-551-7083",
            "fax_number": "678-487-5367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 HIGHWAY 85 N # 310302",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147738",
            "telephone_number": "678-551-7083",
            "fax_number": "678-487-5367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALL",
        "first_name": "ANTHONY",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-26",
        "last_updated": "2022-05-13",
        "certification_date": "2022-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "GA",
            "license": "RN200530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, GA

Sources for this page

Verify at the official NPI Registry.