MEDICARE: MR. JOSEPH THOMAS HANNAN M.D.

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	174400000X	Specialist	025759	GA
2	207R00000X	Internal Medicine Physician	025759	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811170145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH THOMAS HANNAN M.D.

Provider Business Mailing Address
First Line	:	3715 NORTHSIDE PARKWAY NW
Second Line	:	BLDG. 2-100
City	:	ATLANTA
State	:	GA
Zip	:	30327
Country	:	US
Telephone Number	:	770-938-1757
Fax Number	:	770-938-1759

Provider Business Practice Location Address
First Line	:	3715 NORTHSIDE PARKWAY NW
Second Line	:	BLDG. 2-100
City	:	ATLANTA
State	:	GA
Zip	:	30327
Country	:	US
Telephone Number	:	770-938-1757
Fax Number	:	770-938-1759

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

Provider Enumeration Date	:	12/10/2007
Last Update Date	:	05/18/2015

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