Provider Demographics
NPI:1487837969
Name:WAHID HANNA, MD, PC
Entity Type:Organization
Organization Name:WAHID HANNA, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAHID
Authorized Official - Middle Name:T
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-544-9171
Mailing Address - Street 1:1934 ALCOA HWY BLDG D
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1524
Mailing Address - Country:US
Mailing Address - Phone:865-544-9171
Mailing Address - Fax:865-305-6886
Practice Address - Street 1:1928 ALCOA HWY
Practice Address - Street 2:MEDICAL OFFICE BLDG B STE 214
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1502
Practice Address - Country:US
Practice Address - Phone:865-305-9170
Practice Address - Fax:865-305-9876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD12508174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3720357Medicare PIN
TNB04026Medicare UPIN