MEDICARE: ANN R. GORANSON D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213EP1101X	Primary Podiatric Medicine Podiatrist	DPM-368	TN

General Provider Information

NPI Number	:	1174795629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANN R. GORANSON D.P.M.

Provider Business Mailing Address
First Line	:	1413 HATCHER LN
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-3535
Country	:	US
Telephone Number	:	931-381-3020
Fax Number	:

Provider Business Practice Location Address
First Line	:	1413 HATCHER LN
Second Line	:
City	:	COLUMBIA
State	:	TN
Zip	:	38401-3535
Country	:	US
Telephone Number	:	931-381-3020
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANN R GORANSON
Credential	:	DPM
Telephone Number	:	931-381-3020

Provider Enumeration Date	:	03/25/2008
Last Update Date	:	03/25/2008

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