Provider Demographics
NPI:1225202427
Name:HANSRA, DAMIEN M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAMIEN
Middle Name:M
Last Name:HANSRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:DAMIEN
Other - Middle Name:M
Other - Last Name:HANSRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 102231
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-2231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1279 HIGHWAY 54 W STE 100
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4551
Practice Address - Country:US
Practice Address - Phone:770-719-7365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA77829207RH0003X, 207RX0202X
FLME 119249207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology