Provider Demographics
NPI:1194887893
Name:JOSEPH HANNAN M.D.
Entity type:Organization
Organization Name:JOSEPH HANNAN M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:HANNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-526-4999
Mailing Address - Street 1:200 CRUISE CT
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4006
Mailing Address - Country:US
Mailing Address - Phone:770-526-4999
Mailing Address - Fax:770-552-2538
Practice Address - Street 1:200 CRUISE CT
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4006
Practice Address - Country:US
Practice Address - Phone:770-526-4999
Practice Address - Fax:770-552-2538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-16
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC025759251E00000X, 305S00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251E00000XAgenciesHome Health
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00509396CMedicaid
GA00509396CMedicaid
GA00509396CMedicaid