Provider Demographics
NPI:1518994987
Name:HANAK, MARK PAUL (AT,C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:PAUL
Last Name:HANAK
Suffix:
Gender:M
Credentials:AT,C
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Mailing Address - Street 1:111 CHAD CIR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-4695
Mailing Address - Country:US
Mailing Address - Phone:912-399-4020
Mailing Address - Fax:
Practice Address - Street 1:1131 CHAPEL CROSSING RD
Practice Address - Street 2:FEDERAL LAW ENFORCEMENT TRAINING CENTER-BLDG. 252/PTD
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31524-2002
Practice Address - Country:US
Practice Address - Phone:912-280-5310
Practice Address - Fax:912-267-3708
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA7804812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2255A2300XOtherATHLETIC TRAINER