Provider Demographics
NPI:1417147067
Name:ARAM S HANISIAN MD PC
Entity Type:Organization
Organization Name:ARAM S HANISIAN MD PC
Other - Org Name:HANISSIAN CLINIC PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:HANISSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-751-9696
Mailing Address - Street 1:2101 MERCHANTS ROW STE 3
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3862
Mailing Address - Country:US
Mailing Address - Phone:901-751-9696
Mailing Address - Fax:901-757-8960
Practice Address - Street 1:2101 MERCHANTS ROW
Practice Address - Street 2:STE 3
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3862
Practice Address - Country:US
Practice Address - Phone:901-751-9696
Practice Address - Fax:901-757-8960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3709658Medicare PIN