Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 21003 | TN |
N | 208000000X | Pediatrician | 21003 | TN |
NPI | 1093715682 |
---|---|
Provider Name | Dr. William R Hanna JR. |
First Address | Arlington, TN 38002-5122 |
Second Address | Memphis, TN 38103-2816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2005 |
Last Update Date | 05/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3883515 | (05) | TN |
F83303 | (02) | TN |