Provider Demographics
NPI:1083688386
Name:HANNA, RICHARD TINSLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:TINSLEY
Last Name:HANNA
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 1:600 N FANT ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-5704
Mailing Address - Country:US
Mailing Address - Phone:864-512-8150
Mailing Address - Fax:864-512-2925
Practice Address - Street 1:600 N FANT ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5704
Practice Address - Country:US
Practice Address - Phone:864-512-8150
Practice Address - Fax:864-512-2925
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC08386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCC84307Medicare UPIN
SC421878Medicare ID - Type Unspecified