MEDICARE: ARA JAMES HANISSIAN MD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	31681	TN
2	207R00000X	Internal Medicine Physician	29057	TN

General Provider Information

NPI Number	:	1588838411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARA JAMES HANISSIAN MD PLLC

Provider Business Mailing Address
First Line	:	1125 SCHILLING BLVD E
Second Line	:	SUITE 105
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-7078
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1125 SCHILLING BLVD E
Second Line	:	SUITE 105
City	:	COLLIERVILLE
State	:	TN
Zip	:	38017-7078
Country	:	US
Telephone Number	:	901-853-2021
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	ARA JAMES HANISSIAN
Credential	:	MD
Telephone Number	:	901-853-2021

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	06/03/2008

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