Healthcare Provider Details

I. General information

NPI: 1053024497
Provider Name (Legal Business Name): DANIEL K GANN DMIN, MDIV, MACMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2022
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 SONSHINE LN
CHICKAMAUGA GA
30707-3679
US

IV. Provider business mailing address

54 SONSHINE LN
CHICKAMAUGA GA
30707-3679
US

V. Phone/Fax

Practice location:
  • Phone: 256-746-3626
  • Fax:
Mailing address:
  • Phone: 256-746-3626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC015695
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC04854
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: