Healthcare Provider Details

I. General information

NPI: 1669401709
Provider Name (Legal Business Name): DARREN PAUL GANNUCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 WOODS COVE RD
SCOTTSBORO AL
35768-2428
US

IV. Provider business mailing address

6805 GREENHILL BLVD NW
FORT PAYNE AL
35967-8325
US

V. Phone/Fax

Practice location:
  • Phone: 256-505-6826
  • Fax: 256-571-2862
Mailing address:
  • Phone: 256-505-6826
  • Fax: 256-571-2862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number44303
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number2063
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: