MEDICARE: HANNAH HUMPHREY PA-C

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	363A00000X	Physician Assistant	12435	GA

General Provider Information

NPI Number	:	1730917741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH HUMPHREY PA-C

Provider Business Mailing Address
First Line	:	3280 HOWELL MILL RD NW STE 101
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-4107
Country	:	US
Telephone Number	:	404-351-7546
Fax Number	:	404-351-2993

Provider Business Practice Location Address
First Line	:	3280 HOWELL MILL RD NW STE 101
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-4107
Country	:	US
Telephone Number	:	404-351-7546
Fax Number	:	404-351-2993

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2024
Last Update Date	:	11/22/2024

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