Healthcare Provider Details

I. General information

NPI: 1093715682
Provider Name (Legal Business Name): WILLIAM R HANNA JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 08/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 ADAMS AVE
MEMPHIS TN
38103-2816
US

IV. Provider business mailing address

5885 AIRLINE RD UNIT 1011
ARLINGTON TN
38002-5122
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-6112
  • Fax:
Mailing address:
  • Phone: 901-317-7427
  • Fax: 901-317-7585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number21003
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21003
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number21003
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: