Provider Demographics
NPI:1295805554
Name:HANNA, GEORGE M JR (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:M
Last Name:HANNA
Suffix:JR
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:PO BOX 930
Mailing Address - Street 2:
Mailing Address - City:BLOWING ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28605-0930
Mailing Address - Country:US
Mailing Address - Phone:336-262-9168
Mailing Address - Fax:336-262-9168
Practice Address - Street 1:175 MARY ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5025
Practice Address - Country:US
Practice Address - Phone:828-262-9168
Practice Address - Fax:828-262-9168
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111176207RC0000X
RI06573207RC0000X
NC32113207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14NJ0OtherBLUE CROSS BLUE SHIELD
RI006573OtherTUFTS
RI2500480OtherUNITED HEALTH
RI7004900Medicaid
FL754856OtherUNITED HEALTHCARE
E56796Medicare UPIN
RI7004900Medicaid
4185OtherNEIGHBORHOOD HEALTH
RI7004900Medicaid
FL1094858OtherCAREPLUS