Provider Demographics
NPI:1033216148
Name:HANISSIAN, GREGORY ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ANDREW
Last Name:HANISSIAN
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 1:2101 MERCHANTS ROW
Mailing Address - Street 2:STE. 3
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3862
Mailing Address - Country:US
Mailing Address - Phone:901-751-9696
Mailing Address - Fax:901-757-8960
Practice Address - Street 1:2101 MERCHANTS ROW
Practice Address - Street 2:STE. 3
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3862
Practice Address - Country:US
Practice Address - Phone:901-751-9696
Practice Address - Fax:901-757-8960
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25121207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3804423Medicare PIN
TNG33560Medicare UPIN