Provider Demographics
NPI:1083497317
Name:HANNAH, JERRY
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:HANNAH
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 1:101 BARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:NC
Mailing Address - Zip Code:28365-2624
Mailing Address - Country:US
Mailing Address - Phone:252-531-6602
Mailing Address - Fax:
Practice Address - Street 1:101 BARFIELD ST
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:NC
Practice Address - Zip Code:28365-2624
Practice Address - Country:US
Practice Address - Phone:252-531-6602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)