Healthcare Provider Details

I. General information

NPI: 1508382888
Provider Name (Legal Business Name): KRISTEN HANNA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 HUNTER RD
COLUMBUS GA
31906
US

IV. Provider business mailing address

4006 HIGHWAY 34 E
SHARPSBURG GA
30277-3531
US

V. Phone/Fax

Practice location:
  • Phone: 706-569-0727
  • Fax:
Mailing address:
  • Phone: 404-960-1282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW007601
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: