Healthcare Provider Details

I. General information

NPI: 1508837303
Provider Name (Legal Business Name): JAMES C GANT M.D., F.A.A.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 OFFICE PARK DR
JACKSONVILLE NC
28546-7327
US

IV. Provider business mailing address

51 OFFICE PARK DR
JACKSONVILLE NC
28546-7327
US

V. Phone/Fax

Practice location:
  • Phone: 910-577-5199
  • Fax: 910-577-3424
Mailing address:
  • Phone: 910-577-5199
  • Fax: 910-577-3424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number32367
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: