Healthcare Provider Details

I. General information

NPI: 1871693150
Provider Name (Legal Business Name): WAHID HANNA, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1926 ALCOA HWY STE 380 BLDG F
KNOXVILLE TN
37920-1526
US

IV. Provider business mailing address

1926 ALCOA HWY STE 380 BLDG F
KNOXVILLE TN
37920-1526
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 NumberMD12508
License Number StateTN

VIII. Authorized Official

Name: PHYLLIS KIRBY
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 865-305-9883