Healthcare Provider Details

I. General information

NPI: 1043098213
Provider Name (Legal Business Name): GEORGIA ANN HANSBURY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 STEVENS AVE
PORTLAND ME
04103-2656
US

IV. Provider business mailing address

PO BOX 353
HULLS COVE ME
04644-0353
US

V. Phone/Fax

Practice location:
  • Phone: 207-283-0171
  • Fax:
Mailing address:
  • Phone: 207-351-6706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA101715
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: