Provider Demographics
NPI:1053369488
Name:HALL, MARY DONNA (RN, BSN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:DONNA
Last Name:HALL
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:DONNA
Other - Last Name:MCAVOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-2244
Mailing Address - Country:US
Mailing Address - Phone:706-542-0333
Mailing Address - Fax:706-542-9693
Practice Address - Street 1:250 NORTH AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-2244
Practice Address - Country:US
Practice Address - Phone:706-542-0333
Practice Address - Fax:706-542-9693
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN085534163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse