Healthcare Provider Details

I. General information

NPI: 1306892013
Provider Name (Legal Business Name): GERI L GANNAWAY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 GUNBARREL RD SUITE 400
CHATTANOOGA TN
37421-3192
US

IV. Provider business mailing address

1720 GUNBARREL RD SUITE 400
CHATTANOOGA TN
37421-3192
US

V. Phone/Fax

Practice location:
  • Phone: 423-499-4100
  • Fax: 423-499-1945
Mailing address:
  • Phone: 423-499-4100
  • Fax: 423-499-1945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN06084
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN144204
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: