Basic Information
| Provider Information | |||||||||
| NPI: | 1881632099 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANNA | ||||||||
| FirstName: | KAMIL | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | P O BOX 1326 | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2294311022 | ||||||||
| FaxNumber: | 2299031369 | ||||||||
| Practice Location | |||||||||
| Address1: | 425 W 3RD AVE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | ALBANY | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2294311022 | ||||||||
| FaxNumber: | 2299031369 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 02/14/2012 | ||||||||
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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 | 207RC0000X | 2001010086 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | 059422 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 207RC0000X | 059422 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 205682511 | 05 | MO | MEDICAID | 191805 | 01 | BLUE CROSS/BLUE SHIELD | OTHER |