Provider Demographics
NPI:1992799597
Name:HANSON, JOHN WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:HANSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3287
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31604-3287
Mailing Address - Country:US
Mailing Address - Phone:229-245-0447
Mailing Address - Fax:229-245-0448
Practice Address - Street 1:2001 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2944
Practice Address - Country:US
Practice Address - Phone:229-245-0447
Practice Address - Fax:229-245-0448
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040397207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0006695560Medicaid
GA0006695560Medicaid
F83354Medicare UPIN