Individual provider Active NPI

Timothy Joseph Hall, D.M.D.

  • General Practice Dentistry
  • Jacksboro, TN
National Provider Identifier
1912437344
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
10569 Issued in TN
Practice address
147 North St
Jacksboro, TN 37757-2109
Phone
(423) 566-0573
Fax
(423) 562-1133
NPI assigned
Jun 18, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 10569 TN Primary

Addresses

Primary practice location

147 North St
Jacksboro, TN 37757-2109

Mailing address

147 North St
Jacksboro, TN 37757-2109
Phone (423) 566-0573

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
10569TNMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Timothy M Hall DMD PC CurrentSince Jul 24, 2022 Accepting new patients

Locations

147 North St
Jacksboro, TN 37757
Phone (423) 566-0573

Organizations & group practices 1

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": "1497744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1912437344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 NORTH ST",
            "city": "JACKSBORO",
            "state": "TN",
            "postal_code": "377572109",
            "telephone_number": "423-566-0573",
            "fax_number": "423-562-1133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 NORTH ST",
            "city": "JACKSBORO",
            "state": "TN",
            "postal_code": "377572109",
            "telephone_number": "423-566-0573",
            "fax_number": "423-562-1133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALL",
        "first_name": "TIMOTHY",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-18",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "10569",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksboro, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.