Provider Demographics
NPI:1992498125
Name:ATTALLA HANNA, GEORGE NABIL
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:NABIL
Last Name:ATTALLA HANNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8524 HANNARY CIR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-4092
Mailing Address - Country:US
Mailing Address - Phone:850-284-6580
Mailing Address - Fax:
Practice Address - Street 1:4067 LAGNIAPPE WAY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32317-1201
Practice Address - Country:US
Practice Address - Phone:850-219-2509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS64708183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist