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General NPI Number Information
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NPI Number | 1518994987
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Entity Type | Individual
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Provider Name | MARK PAUL HANAK A.T.,C.
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Gender | Male
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1131 CHAPEL CROSSING RD FEDERAL LAW ENFORCEMENT TRAINING CENTER-BLDG. 252/PTD
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City | BRUNSWICK
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State | GA
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Zip | 31524-2002
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Country | US
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Telephone | 912-280-5310
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Fax | 912-267-3708
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Provider Business Mailing Address
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Address Line | 111 CHAD CIR
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City | BRUNSWICK
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State | GA
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Zip | 31525-4695
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Country | US
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Telephone | 912-399-4020
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 780481
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License Number State | GA
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