Healthcare Provider Details

I. General information

NPI: 1093761124
Provider Name (Legal Business Name): WAHID T HANNA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1926 ALCOA HWY BLDG. F, SUITE 380
KNOXVILLE TN
37920-1545
US

IV. Provider business mailing address

1926 ALCOA HWY BLDG. F, SUITE 380
KNOXVILLE TN
37920-1545
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number4771413
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: