Individual
GINA R. HANISSIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
574 GREENTREE COVE, SUITE 101, COLLIERVILLE, TN 38017
(901) 853-2021
(901) 853-2434
Mailing address
6799 GREAT OAKS RD #250, SUITE 250, MEMPHIS, TN 38138
(901) 261-0700
(901) 261-0701
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
31681
TN
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
31681
TN
208000000X
Pediatrics Physician
31681
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4036588
BCBS PROVIDER
TN
Enumeration date
11/27/2006
Last updated
01/26/2010
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