MEDICARE: GERI L GANNAWAY FNP

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	363LF0000X	Family Nurse Practitioner	APN06084	TN
2	363LF0000X	Family Nurse Practitioner	RN144204	GA

General Provider Information

NPI Number	:	1306892013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERI L GANNAWAY FNP

Provider Business Mailing Address
First Line	:	1720 GUNBARREL RD
Second Line	:	SUITE 400
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-3192
Country	:	US
Telephone Number	:	423-499-4100
Fax Number	:	423-499-1945

Provider Business Practice Location Address
First Line	:	1720 GUNBARREL RD
Second Line	:	SUITE 400
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-3192
Country	:	US
Telephone Number	:	423-499-4100
Fax Number	:	423-499-1945

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	07/08/2007

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