Provider Demographics
NPI:1770501827
Name:HANNA, PAUL C (DDS, PC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:C
Last Name:HANNA
Suffix:
Gender:M
Credentials:DDS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 HAROBI DR STE A
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-5161
Mailing Address - Country:US
Mailing Address - Phone:404-325-1221
Mailing Address - Fax:404-636-0663
Practice Address - Street 1:2012 HAROBI DR STE A
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5161
Practice Address - Country:US
Practice Address - Phone:404-325-1221
Practice Address - Fax:404-636-0663
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7732122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA58-1584344OtherTAX ID