Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY002892 | GA |
Y | 103TC0700X | Clinical Psychologist | PSY002892 | GA |
NPI | 1003823568 |
---|---|
Provider Name | Dr. Gary Ryan Hann |
First Address | Fort Gordon, GA 30905-5650 |
Second Address | Fort Gordon, GA 30905-5650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 06/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
952478774B | (05) | GA |