| Jacquelyn Hall-davis,m.d. Ltd | |
|
1669 Windham Way Suite B O Fallon IL 62269-3072 | |
| (618) 622-9240 | |
| (618) 622-9241 |
| Full Name | Jacquelyn Hall-davis,m.d. Ltd |
|---|---|
| Speciality | Psychiatry & Neurology - Child & Adolescent Psychiatry |
| Location | 1669 Windham Way, O Fallon, Illinois |
| Authorized Official Name and Position | Jacquelyn Hall-davis (PRESIDENT) |
| Authorized Official Contact | 6186229240 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jacquelyn Hall-davis,m.d. Ltd 1669 Windham Way Suite B O Fallon IL 62269-3072 Ph: (618) 622-9240 | Jacquelyn Hall-davis,m.d. Ltd 1669 Windham Way Suite B O Fallon IL 62269-3072 Ph: (618) 622-9240 |
| NPI Number | 1699173542 |
|---|---|
| Provider Enumeration Date | 12/09/2014 |
| Last Update Date | 12/09/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699173542 | NPI | - | NPPES |
| 540653 | Other | IL | TRICARE |
| 036080270 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | 036080270 (Illinois) | Primary |
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