Active NPI
Mario Hanna
- Pharmacist
- Brunswick, GA
National Provider Identifier
1083105837
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 030461
- Practice address
- 4575 Altama Ave
Brunswick, GA 31520-3008 - Phone
- (925) 917-1507
- NPI assigned
- May 27, 2018
- Last updated
- Dec 22, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 030461 | GA | Primary |
Addresses
Primary practice location
4575 Altama Ave
Brunswick, GA 31520-3008
Mailing address
4575 Altama Ave
Brunswick, GA 31520-3008
Phone (912) 261-2593
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 030461 | GA | MD | Anatomic Pathology & Clinical Pathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
4575 Altama Ave
Brunswick, GA 31520
Phone (912) 261-2593
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527379200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671667200000",
"number": "1083105837",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4575 ALTAMA AVE",
"city": "BRUNSWICK",
"state": "GA",
"postal_code": "315203008",
"telephone_number": "912-261-2593",
"fax_number": "912-261-8697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4575 ALTAMA AVE",
"city": "BRUNSWICK",
"state": "GA",
"postal_code": "315203008",
"telephone_number": "925-917-1507"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANNA",
"first_name": "MARIO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-05-27",
"last_updated": "2022-12-22",
"certification_date": "2022-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "030461",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brunswick, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.