Healthcare Provider Details

I. General information

NPI: 1528066495
Provider Name (Legal Business Name): GANG GARY TIAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7945 WOLF RIVER BOULEVARD
GERMANTOWN TN
38138
US

IV. Provider business mailing address

7945 WOLF RIVER BOULEVARD
GERMANTOWN TN
38138
US

V. Phone/Fax

Practice location:
  • Phone: 901-683-0055
  • Fax: 901-922-6701
Mailing address:
  • Phone: 901-683-0055
  • Fax: 901-922-6701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number18163
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberE3740
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number37455
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: