=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700848363
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CARL ROBERT HANNAH M.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/06/2006
-----------------------------------------------------
Last Update Date | 01/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 HICKOK ST
-----------------------------------------------------
City | CHRISTIANSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24073-3524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-383-6148
-----------------------------------------------------
Fax | 540-382-4191
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 HICKOK ST
-----------------------------------------------------
City | CHRISTIANSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24073-3524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-383-6148
-----------------------------------------------------
Fax | 540-382-4191
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 0101235860
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------