Provider Demographics
NPI:1508507336
Name:HANNAH, MIRANDA FERN (MD)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:FERN
Last Name:HANNAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 N RAVENEL ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2641
Mailing Address - Country:US
Mailing Address - Phone:843-777-2800
Mailing Address - Fax:
Practice Address - Street 1:144 N RAVENEL ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2641
Practice Address - Country:US
Practice Address - Phone:843-777-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SCMMD.87779.LL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program