Healthcare Provider Details

I. General information

NPI: 1467770214
Provider Name (Legal Business Name): COURTNEY ALEXANDRA HANNA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 19TH ST SUITE 301
KNOXVILLE TN
37916-1854
US

IV. Provider business mailing address

501 20TH ST SUITE G-3
KNOXVILLE TN
37916-1809
US

V. Phone/Fax

Practice location:
  • Phone: 865-522-7591
  • Fax: 865-525-9662
Mailing address:
  • Phone: 865-522-7591
  • Fax: 865-525-9662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number54095
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number54095
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: