Provider Demographics
NPI:1093761124
Name:HANNA, WAHID T (MD)
Entity Type:Individual
Prefix:
First Name:WAHID
Middle Name:T
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 1:1926 ALCOA HWY
Mailing Address - Street 2:BLDG. F, SUITE 380
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1545
Mailing Address - Country:US
Mailing Address - Phone:865-544-9171
Mailing Address - Fax:865-305-6886
Practice Address - Street 1:1926 ALCOA HWY
Practice Address - Street 2:BLDG. F, SUITE 380
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1545
Practice Address - Country:US
Practice Address - Phone:865-544-9171
Practice Address - Fax:865-305-6886
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4771413207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN12508Medicaid
TN3720357Medicare PIN
TN12508Medicaid
TN3720356Medicare PIN