Provider Demographics
NPI:1689639072
Name:HANNA, DONALD TIMOTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:TIMOTHY
Last Name:HANNA
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 1:100 SPRING HALL DR
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-5335
Mailing Address - Country:US
Mailing Address - Phone:843-572-8201
Mailing Address - Fax:843-797-8491
Practice Address - Street 1:100 SPRING HALL DR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-5335
Practice Address - Country:US
Practice Address - Phone:843-572-8201
Practice Address - Fax:843-797-8491
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC115351Medicaid
SCAH1697068OtherDEA#
SCD055083163Medicare ID - Type Unspecified
SCAH1697068OtherDEA#