Provider Demographics
NPI:1811170145
Name:HANNAN, JOSEPH THOMAS (MD)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:THOMAS
Last Name:HANNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3715 NORTHSIDE PARKWAY NW
Mailing Address - Street 2:BLDG. 2-100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327
Mailing Address - Country:US
Mailing Address - Phone:770-938-1757
Mailing Address - Fax:770-938-1759
Practice Address - Street 1:3715 NORTHSIDE PARKWAY NW
Practice Address - Street 2:BLDG. 2-100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327
Practice Address - Country:US
Practice Address - Phone:770-938-1757
Practice Address - Fax:770-938-1759
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025759174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00509396CMedicaid
GA11BDLSSMedicare PIN
GA00509396CMedicaid
GA11BDLSSMedicare Oscar/Certification