Healthcare Provider Details

I. General information

NPI: 1790178564
Provider Name (Legal Business Name): MARTHA HANNA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2484 E PINETREE BLVD
THOMASVILLE GA
31792-4854
US

IV. Provider business mailing address

2484 E PINETREE BLVD
THOMASVILLE GA
31792-4854
US

V. Phone/Fax

Practice location:
  • Phone: 229-226-8800
  • Fax: 229-226-8232
Mailing address:
  • Phone: 229-226-8800
  • Fax: 229-226-8232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN082087
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: