Provider Demographics
NPI:1174508303
Name:HANNIFIN, JAMES FANCIS (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:FANCIS
Last Name:HANNIFIN
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 3090
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37320-3090
Mailing Address - Country:US
Mailing Address - Phone:423-472-6513
Mailing Address - Fax:423-476-2062
Practice Address - Street 1:2080 CHAMBLISS AVE NW
Practice Address - Street 2:CLEVELAND ANESTHESIOLOGISTS INC
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3894
Practice Address - Country:US
Practice Address - Phone:423-472-6514
Practice Address - Fax:423-476-2062
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD11707207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3178074Medicaid
TN3178075Medicare ID - Type Unspecified
TN3178074Medicaid