=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487837969
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WAHID HANNA, MD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2007
-----------------------------------------------------
Last Update Date | 02/14/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1928 ALCOA HWY MEDICAL OFFICE BLDG B STE 214
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37920-1502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-305-9170
-----------------------------------------------------
Fax | 865-305-9876
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1934 ALCOA HWY BLDG D
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37920-1524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-544-9171
-----------------------------------------------------
Fax | 865-305-6886
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | WAHID T HANNA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 865-544-9171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MD12508
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------