Individual
MARY KATHRYN HANISEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
100 MIMOSA DR, THOMASVILLE, GA 31792-6676
(229) 226-8881
Mailing address
100 MIMOSA DR, THOMASVILLE, GA 31792-6676
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
078665
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2011
Last updated
08/03/2020
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