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General NPI Number Information
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NPI Number | 1528066495
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Entity Type | Individual
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Provider Name | GANG GARY TIAN M.D
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Gender | Male
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 7945 WOLF RIVER BOULEVARD
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City | GERMANTOWN
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State | TN
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Zip | 38138
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Country | US
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Telephone | 901-683-0055
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Fax | 901-922-6701
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Provider Business Mailing Address
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Address Line | 7945 WOLF RIVER BOULEVARD
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City | GERMANTOWN
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State | TN
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Zip | 38138
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Country | US
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Telephone | 901-683-0055
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Fax | 901-922-6701
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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 | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 18163
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | E3740
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 37455
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License Number State | TN
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