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NPI Code Detail

MEDICARE: JAMES GANNAWAY

MEDICARE: JAMES GANNAWAY
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
11041C0700XClinical Social WorkerISW00664RI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
124033-8OTHERRIBLUE CROSS
2406403OTHERRIBLUE CHIP
362-19392OTHERRIUNITED BEHAVIORAL HEALTH

General Provider Information

NPI Number : 1528003811
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES GANNAWAY
Provider Business Mailing Address
First Line : 951 N MAIN ST
Second Line :
City : PROVIDENCE
State : RI
Zip : 02904-5759
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 520 HOPE ST
Second Line :
City : PROVIDENCE
State : RI
Zip : 02906-2532
Country : US
Telephone Number : 401-276-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2006
Last Update Date : 07/08/2007

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Directions to “ JAMES GANNAWAY ” Practice Location

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