Provider Demographics
NPI:1871693150
Name:WAHID HANNA, MD, PC
Entity type:Organization
Organization Name:WAHID HANNA, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-305-9883
Mailing Address - Street 1:1926 ALCOA HWY STE 380 BLDG F
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1526
Mailing Address - Country:US
Mailing Address - Phone:865-544-9171
Mailing Address - Fax:865-305-6886
Practice Address - Street 1:1926 ALCOA HWY STE 380 BLDG F
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1526
Practice Address - Country:US
Practice Address - Phone:865-544-9171
Practice Address - Fax:865-305-6886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD12508207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3182815Medicaid
TN12508Medicaid
TN3720357Medicare ID - Type UnspecifiedMEDICARE NUMBER
TN3182818Medicare PIN
TNI54213Medicare UPIN
TN3338867Medicare PIN
TN3338867Medicare ID - Type UnspecifiedMEDICARE
TN3182815Medicaid