Organization
PATRICIA M. HANNAN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ANN PENIX RN, MSN (PRESIDENT)
(706) 828-6868
Entity
Organization
Contact information
Practice address
611 TELFAIR ST, AUGUSTA, GA 30901-2324
(706) 828-6868
(706) 828-7098
Mailing address
110 PEPPER HILL WAY, AIKEN, SC 29801-2818
(706) 828-6868
(706) 828-7098
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
2288
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AN0591
—
SC
Enumeration date
04/18/2007
Last updated
08/22/2020
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