Provider Demographics
NPI:1871172775
Name:HANNA, TIMOTHY DONALD (NP)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DONALD
Last Name:HANNA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 SAINT JOHNS PARRISH WAY
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-3162
Mailing Address - Country:US
Mailing Address - Phone:843-714-7962
Mailing Address - Fax:
Practice Address - Street 1:3601 LADSON RD
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-4304
Practice Address - Country:US
Practice Address - Phone:843-285-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24860363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health