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General NPI Number Information
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NPI Number | 1720204308
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Entity Type | Organization
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Legal Business Name | PATRICIA M. HANNAN
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 611 TELFAIR ST
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City | AUGUSTA
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State | GA
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Zip | 30901-2324
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Country | US
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Telephone | 706-828-6868
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Fax | 706-828-7098
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Provider Business Mailing Address
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Address Line | 110 PEPPER HILL WAY
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City | AIKEN
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State | SC
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Zip | 29801-2818
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Country | US
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Telephone | 706-828-6868
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Fax | 706-828-7098
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY ANN PENIX
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Credential | RN, MSN
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Telephone | 706-828-6868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 2288
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License Number State | SC
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