Provider Demographics
NPI:1619135563
Name:HANSEN, NATHANIEL JAMES (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:JAMES
Last Name:HANSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3037 MASSEY RD
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-3603
Mailing Address - Country:US
Mailing Address - Phone:205-874-9805
Mailing Address - Fax:205-874-9806
Practice Address - Street 1:3037 MASSEY RD
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-3603
Practice Address - Country:US
Practice Address - Phone:205-874-9805
Practice Address - Fax:205-874-9806
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AL303772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program