Basic Information
| Provider Information | |||||||||
| NPI: | 1811170145 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANNAN | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3715 NORTHSIDE PARKWAY NW | ||||||||
| Address2: | BLDG. 2-100 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709381757 | ||||||||
| FaxNumber: | 7709381759 | ||||||||
| Practice Location | |||||||||
| Address1: | 3715 NORTHSIDE PARKWAY NW | ||||||||
| Address2: | BLDG. 2-100 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709381757 | ||||||||
| FaxNumber: | 7709381759 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2007 | ||||||||
| LastUpdateDate: | 05/18/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 025759 | GA | N | Other Service Providers | Specialist | 207R00000X | 025759 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00509396C | 05 | GA | MEDICAID |