Healthcare Provider Details

I. General information

NPI: 1053514547
Provider Name (Legal Business Name): WAHID HANNA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11440 PARKSIDE DR SUITE 202
KNOXVILLE TN
37934-2658
US

IV. Provider business mailing address

1934 ALCOA HWY BLDG D SUITE 472
KNOXVILLE TN
37920-1524
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 Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: WAHID T HANNA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 865-544-9171