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General NPI Number Information
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NPI Number | 1225846793
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Entity Type | Individual
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Provider Name | IMANI SARAN GUNN
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Gender | Female
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 7450 GA HIGHWAY 21 UNIT 912
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City | PORT WENTWORTH
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State | GA
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Zip | 31407-1145
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Country | US
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Telephone | 912-419-0333
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Fax |
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Provider Business Mailing Address
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Address Line | 7450 US HIGHWAY 21
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City | PORT WENTWORTH
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State | GA
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Zip | 31407-1145
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Country | US
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Telephone | 912-419-0333
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 102X00000X
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Taxonomy Name | Poetry Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 374K00000X
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Taxonomy Name | Religious Nonmedical Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 374J00000X
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Taxonomy Name | Doula
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License Number |
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License Number State | GA
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Taxonomy #8
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Taxonomy Code | 374T00000X
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Taxonomy Name | Religious Nonmedical Nursing Personnel
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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