Healthcare Provider Details

I. General information

NPI: 1871772590
Provider Name (Legal Business Name): TAMMY GANTT CRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 BUCKINGHAM DR
FRANKLINTON NC
27525-8042
US

IV. Provider business mailing address

45 BUCKINGHAM DR
FRANKLINTON NC
27525-8042
US

V. Phone/Fax

Practice location:
  • Phone: 919-602-3303
  • Fax:
Mailing address:
  • Phone: 919-602-3303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberA4707
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: