Healthcare Provider Details

I. General information

NPI: 1487837969
Provider Name (Legal Business Name): WAHID HANNA, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1928 ALCOA HWY MEDICAL OFFICE BLDG B STE 214
KNOXVILLE TN
37920-1502
US

IV. Provider business mailing address

1934 ALCOA HWY BLDG D
KNOXVILLE TN
37920-1524
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9170
  • Fax: 865-305-9876
Mailing address:
  • Phone: 865-544-9171
  • Fax: 865-305-6886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD12508
License Number StateTN

VIII. Authorized Official

Name: WAHID T HANNA
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 865-544-9171