Provider Demographics
NPI:1497187678
Name:PATRICIA M. HANNAN, CRNA, LLC
Entity Type:Organization
Organization Name:PATRICIA M. HANNAN, CRNA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SELF/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MACK
Authorized Official - Last Name:HANNAN
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:803-293-8080
Mailing Address - Street 1:ONE TENTH STREET
Mailing Address - Street 2:SUITE 400
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-0126
Mailing Address - Country:US
Mailing Address - Phone:706-722-9090
Mailing Address - Fax:706-722-9092
Practice Address - Street 1:110 PEPPER HILL WAY
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-2818
Practice Address - Country:US
Practice Address - Phone:703-642-6060
Practice Address - Fax:803-642-0754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA571116450367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty