Healthcare Provider Details

I. General information

NPI: 1326057167
Provider Name (Legal Business Name): GARY G. GALLANT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 S HARTMANN DR STE 110
LEBANON TN
37090-4137
US

IV. Provider business mailing address

920 S HARTMANN DR STE 110
LEBANON TN
37090-4137
US

V. Phone/Fax

Practice location:
  • Phone: 615-994-4110
  • Fax: 615-994-4113
Mailing address:
  • Phone: 615-994-4110
  • Fax: 615-994-4113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14510
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: