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General NPI Number Information
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NPI Number | 1689217911
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Entity Type | Individual
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Provider Name | DAVID JEFFREY HANSON PAC
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Gender | Male
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Dates
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Enumeration Date | 10/18/2019
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 105 GRAND CENTRAL BLVD STE 108
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City | POOLER
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State | GA
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Zip | 31322-4148
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Country | US
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Telephone | 912-748-1515
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Fax | 844-807-3782
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Provider Business Mailing Address
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Address Line | 105 GRAND CENTRAL BLVD STE 108
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City | POOLER
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State | GA
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Zip | 31322-4148
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Country | US
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Telephone | 912-748-1515
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Fax | 208-625-2070
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA1806
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA1806
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 12647
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License Number State | GA
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