Provider Demographics
NPI:1447823083
Name:HANSEN, DENNY JAMES
Entity type:Individual
Prefix:
First Name:DENNY
Middle Name:JAMES
Last Name:HANSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 DEEP SOUTH FARM RD
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-2298
Mailing Address - Country:US
Mailing Address - Phone:770-345-6600
Mailing Address - Fax:
Practice Address - Street 1:97 DEEP SOUTH FARM RD
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-2298
Practice Address - Country:US
Practice Address - Phone:770-345-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN244216163W00000X
GANCO-000001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
GANCO-000001OtherGEORGIA BOARD OF NURSING APRN LICENSE
RN244216OtherBOARD OF NURSING RN LICENSE
F06210691OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS