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General NPI Number Information
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NPI Number | 1194887893
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Entity Type | Organization
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Legal Business Name | JOSEPH HANNAN M.D.
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Dates
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Enumeration Date | 12/16/2006
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 200 CRUISE CT
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City | ROSWELL
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State | GA
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Zip | 30076-4006
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Country | US
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Telephone | 770-526-4999
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Fax | 770-552-2538
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Provider Business Mailing Address
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Address Line | 200 CRUISE CT
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City | ROSWELL
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State | GA
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Zip | 30076-4006
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Country | US
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Telephone | 770-526-4999
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Fax | 770-552-2538
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JOSEPH T HANNAN
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Credential | M.D.
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Telephone | 770-526-4999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 025759
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 025759
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 025759
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License Number State | DC
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