Provider Demographics
NPI:1598177768
Name:CARNEY, GINA HANAFI (DMD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:HANAFI
Last Name:CARNEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 TROTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-7003
Mailing Address - Country:US
Mailing Address - Phone:931-381-9721
Mailing Address - Fax:931-381-3507
Practice Address - Street 1:6000 TROTWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-7003
Practice Address - Country:US
Practice Address - Phone:931-381-9721
Practice Address - Fax:931-381-3507
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-22
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0148221223G0001X
TN100321223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ015191Medicaid