Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | T-4505 | MS |
N | 207XS0106X | Orthopaedic Hand Surgeon | T-4505 | MS |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | T-4505 | MS |
NPI | 1306464169 |
---|---|
Provider Name | Tammam Hanna |
First Address | Jackson, MS 39216 |
Second Address | Jackson, MS 39216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2020 |
Last Update Date | 10/09/2021 |