Healthcare Provider Details

I. General information

NPI: 1194887893
Provider Name (Legal Business Name): JOSEPH HANNAN M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CRUISE CT
ROSWELL GA
30076-4006
US

IV. Provider business mailing address

200 CRUISE CT
ROSWELL GA
30076-4006
US

V. Phone/Fax

Practice location:
  • Phone: 770-526-4999
  • Fax: 770-552-2538
Mailing address:
  • Phone: 770-526-4999
  • Fax: 770-552-2538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number025759
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number025759
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number025759
License Number StateDC

VIII. Authorized Official

Name: DR. JOSEPH T HANNAN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 770-526-4999