Healthcare Provider Details

I. General information

NPI: 1861496853
Provider Name (Legal Business Name): CHARLES D GANIME D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 HOSPITAL RD STE I
WINCHESTER TN
37398-2495
US

IV. Provider business mailing address

155 HOSPITAL RD STE I
WINCHESTER TN
37398-2495
US

V. Phone/Fax

Practice location:
  • Phone: 931-968-9191
  • Fax: 931-968-9081
Mailing address:
  • Phone: 931-968-9191
  • Fax: 931-968-9081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDPM0000000591
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDPM0000000591
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberDPM0000000591
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: