Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 25121 | TN |
NPI | 1033216148 |
---|---|
Provider Name | Gregory Andrew Hanissian |
First Address | Germantown, TN 38138-3862 |
Second Address | Germantown, TN 38138-3862 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 11/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G33560 | (02) | TN |