Healthcare Provider Details

I. General information

NPI: 1396375267
Provider Name (Legal Business Name): GANA HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2020
Last Update Date: 04/09/2022
Certification Date: 04/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 MEDICAL ST
SNEAD AL
35952-6468
US

IV. Provider business mailing address

PO BOX 555
SNEAD AL
35952-0555
US

V. Phone/Fax

Practice location:
  • Phone: 53-864-3412
  • Fax: 205-466-7437
Mailing address:
  • Phone: 205-386-4341
  • Fax: 205-466-7437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ENRICO D GASPAR
Title or Position: OWNER
Credential: MD
Phone: 256-840-8181