Provider Demographics
NPI:1194434217
Name:HANKS, MARISA DENISE
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:DENISE
Last Name:HANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 HOLLISTER DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-8747
Mailing Address - Country:US
Mailing Address - Phone:912-399-2486
Mailing Address - Fax:
Practice Address - Street 1:176 HOLLISTER DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721-8747
Practice Address - Country:US
Practice Address - Phone:912-399-2486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor