Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | MD20857 | TN |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD20857 | TN |
N | 2081S0010X | Sports Medicine | MD20857 | TN |
N | 213ES0000X | Sports Medicine | MD20857 | TN |
NPI | 1356433783 |
---|---|
Provider Name | Gene Hannah |
First Address | Nashville, TN 37232-8774 |
Second Address | Nashville, TN 37232-5100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2006 |
Last Update Date | 15/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E84710 | (02) |