Healthcare Provider Details

I. General information

NPI: 1942357744
Provider Name (Legal Business Name): ERNEST C HAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

663 LANIER PARK DR
GAINESVILLE GA
30501-2059
US

IV. Provider business mailing address

663 LANIER PARK DR
GAINESVILLE GA
30501-2059
US

V. Phone/Fax

Practice location:
  • Phone: 678-450-0202
  • Fax: 678-450-0080
Mailing address:
  • Phone: 678-450-0202
  • Fax: 678-450-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number062511
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: