Healthcare Provider Details

I. General information

NPI: 1689639072
Provider Name (Legal Business Name): DONALD TIMOTHY HANNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SPRING HALL DR
GOOSE CREEK SC
29445-5335
US

IV. Provider business mailing address

100 SPRING HALL DR
GOOSE CREEK SC
29445-5335
US

V. Phone/Fax

Practice location:
  • Phone: 843-572-8201
  • Fax: 843-797-8491
Mailing address:
  • Phone: 843-572-8201
  • Fax: 843-797-8491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11535
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: