Provider Demographics
NPI:1063405942
Name:HANNA, MATTHEW BRYAN (PA)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:BRYAN
Last Name:HANNA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 FLOYD ST
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-5509
Mailing Address - Country:US
Mailing Address - Phone:912-369-4789
Mailing Address - Fax:
Practice Address - Street 1:6167 BRAIDED MANE PASS SW
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7839
Practice Address - Country:US
Practice Address - Phone:803-648-1464
Practice Address - Fax:803-649-2027
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA1066581363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant