Provider Demographics
NPI:1467163725
Name:HANNON, LOUIS MACK
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:MACK
Last Name:HANNON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1096 REDAN TRCE
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-2900
Mailing Address - Country:US
Mailing Address - Phone:678-327-3089
Mailing Address - Fax:
Practice Address - Street 1:1096 REDAN TRCE
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-2900
Practice Address - Country:US
Practice Address - Phone:678-327-3089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician