Healthcare Provider Details

I. General information

NPI: 1396718698
Provider Name (Legal Business Name): HANY ELIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 09/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 MIKE PADGETT HWY
AUGUSTA GA
30906-3815
US

IV. Provider business mailing address

3712 MERION DR
MARTINEZ GA
30907-9033
US

V. Phone/Fax

Practice location:
  • Phone: 706-432-7893
  • Fax: 706-432-3780
Mailing address:
  • Phone: 706-432-7833
  • Fax: 706-432-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberGA030055
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: