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General NPI Number Information
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NPI Number | 1710115605
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Entity Type | Individual
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Provider Name | MARY ANN HANNA HORN D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/30/2009
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Last Update Date | 09/17/2015
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Provider Practice Location Address
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Address Line | 400 BUCKWALTER PLACE BLVD.
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City | BLUFFTON
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State | SC
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Zip | 29910
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Country | US
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Telephone | 800-420-3471
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Fax |
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Provider Business Mailing Address
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Address Line | 4015 WEATHERSTONE WAY
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City | ANDERSON
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State | SC
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Zip | 29621
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Country | US
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Telephone | 843-424-2747
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Fax | 843-424-2747
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1167
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 5101018234
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License Number State | MI
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