Healthcare Provider Details

I. General information

NPI: 1881632099
Provider Name (Legal Business Name): KAMIL I HANNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W 3RD AVE SUITE 600
ALBANY GA
31701
US

IV. Provider business mailing address

P O BOX 1326
ALBANY GA
31702
US

V. Phone/Fax

Practice location:
  • Phone: 229-431-1022
  • Fax: 229-903-1369
Mailing address:
  • Phone: 229-431-1022
  • Fax: 229-903-1369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2001010086
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number059422
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number059422
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: