Healthcare Provider Details

I. General information

NPI: 1639505951
Provider Name (Legal Business Name): MARK RICHARD HANNAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MARK RICHARD HANNAY MD

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 TOWNE CENTER BLVD BLDG 1200
POOLER GA
31322-4129
US

IV. Provider business mailing address

1339 E 53RD ST
SAVANNAH GA
31404-4605
US

V. Phone/Fax

Practice location:
  • Phone: 706-266-2411
  • Fax:
Mailing address:
  • Phone: 706-266-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number104494
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0101263782
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: