Provider Demographics
NPI:1588838411
Name:ARA JAMES HANISSIAN MD PLLC
Entity Type:Organization
Organization Name:ARA JAMES HANISSIAN MD PLLC
Other - Org Name:HANISSIAN HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ARA
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HANISSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-853-2021
Mailing Address - Street 1:1125 SCHILLING BLVD E
Mailing Address - Street 2:SUITE 105
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-7078
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1125 SCHILLING BLVD E
Practice Address - Street 2:SUITE 105
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-7078
Practice Address - Country:US
Practice Address - Phone:901-853-2021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29057207R00000X
TN31681208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3377064Medicare PIN