Provider Demographics
NPI:1184390312
Name:HANSON, THEODORE T (PARAMEDIC)
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:T
Last Name:HANSON
Suffix:
Gender:M
Credentials:PARAMEDIC
Other - Prefix:
Other - First Name:TED
Other - Middle Name:
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PARAMEDIC
Mailing Address - Street 1:1343 BAILEYS COR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-2072
Mailing Address - Country:US
Mailing Address - Phone:404-444-3040
Mailing Address - Fax:
Practice Address - Street 1:1343 BAILEYS COR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-2072
Practice Address - Country:US
Practice Address - Phone:404-444-3040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAP012395146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic