Healthcare Provider Details

I. General information

NPI: 1003831900
Provider Name (Legal Business Name): G DWAYNE GANN R,MR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 13TH AVE SE
DECATUR AL
35601-4300
US

IV. Provider business mailing address

1804 WOODALL RD SW
DECATUR AL
35603-4314
US

V. Phone/Fax

Practice location:
  • Phone: 256-350-7779
  • Fax: 256-350-2272
Mailing address:
  • Phone: 256-306-0554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number259436
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number259436
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: