Provider Demographics
NPI:1245205616
Name:HANNER, JAMES SHAPARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:SHAPARD
Last Name:HANNER
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 403444
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-3444
Mailing Address - Country:US
Mailing Address - Phone:813-348-6951
Mailing Address - Fax:813-348-6999
Practice Address - Street 1:4516 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2732
Practice Address - Country:US
Practice Address - Phone:813-348-6951
Practice Address - Fax:813-348-6999
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53514174400000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064819100Medicaid
FL300030997OtherRR MCR
FLE81185Medicare UPIN
FL064819100Medicaid