Provider Demographics
NPI:1962850651
Name:HANOS, DUSTIN STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:STANLEY
Last Name:HANOS
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 1:711 PRIVATE LN
Mailing Address - Street 2:
Mailing Address - City:UNION BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07735-3241
Mailing Address - Country:US
Mailing Address - Phone:732-997-8399
Mailing Address - Fax:
Practice Address - Street 1:69 JESSE HILL JR. DRIVE, SW
Practice Address - Street 2:GLENN MEMORIAL BUILDING, 3RD FLOOR
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:404-251-8915
Practice Address - Fax:404-523-3931
Is Sole Proprietor?:No
Enumeration Date:2016-06-02
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA88406208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program