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General NPI Number Information
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NPI Number | 1548419310
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Entity Type | Individual
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Provider Name | THOMAS MILTON GANNON D.O.
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Gender | Male
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Dates
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Enumeration Date | 09/16/2008
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Last Update Date | 11/06/2019
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Provider Practice Location Address
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Address Line | 404 N WILLOW AVE
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City | COOKEVILLE
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State | TN
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Zip | 38501
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Country | US
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Telephone | 931-854-9393
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Fax | 931-233-2449
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Provider Business Mailing Address
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Address Line | 404 N WILLOW AVE
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City | COOKEVILLE
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State | TN
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Zip | 38501-2339
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Country | US
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Telephone | 931-854-9393
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Fax | 931-233-2449
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 1785
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License Number State | VA
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