Healthcare Provider Details

I. General information

NPI: 1013050368
Provider Name (Legal Business Name): FRANKLIN W FANNIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2245 WINCHESTER AVE
ASHLAND KY
41101-7848
US

IV. Provider business mailing address

PO BOX 1595
ASHLAND KY
41105-1595
US

V. Phone/Fax

Practice location:
  • Phone: 606-408-2600
  • Fax: 606-408-2605
Mailing address:
  • Phone: 606-408-5044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR1106
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: