Provider Demographics
NPI:1881632099
Name:HANNA, KAMIL I (MD)
Entity type:Individual
Prefix:
First Name:KAMIL
Middle Name:I
Last Name:HANNA
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:P O BOX 1326
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31702
Mailing Address - Country:US
Mailing Address - Phone:229-431-1022
Mailing Address - Fax:229-903-1369
Practice Address - Street 1:425 W 3RD AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701
Practice Address - Country:US
Practice Address - Phone:229-431-1022
Practice Address - Fax:229-903-1369
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001010086207RC0000X
GA059422207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205682511Medicaid
191805OtherBLUE CROSS/BLUE SHIELD
917774838Medicare ID - Type Unspecified
191805OtherBLUE CROSS/BLUE SHIELD