Provider Demographics
NPI:1588673990
Name:HANNAH, SCOTT EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:EDWARD
Last Name:HANNAH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 LOWER KINGS BRIDGE RD NE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-7051
Mailing Address - Country:US
Mailing Address - Phone:706-259-3640
Mailing Address - Fax:706-279-2062
Practice Address - Street 1:1805 E WALNUT AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-4338
Practice Address - Country:US
Practice Address - Phone:706-278-1252
Practice Address - Fax:706-279-2062
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000722152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU40442Medicare UPIN
GA41ZCDFLMedicare ID - Type UnspecifiedMEDICARE NUMBER