Healthcare Provider Details

I. General information

NPI: 1407922867
Provider Name (Legal Business Name): SCOTT JOSEPH HANEGAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 10/31/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 22ND AVE
MERIDIAN MS
39301-3223
US

IV. Provider business mailing address

PO BOX 749215
ATLANTA GA
30374-9215
US

V. Phone/Fax

Practice location:
  • Phone: 601-483-5322
  • Fax:
Mailing address:
  • Phone: 901-226-3186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number80165
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number80165
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: