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General NPI Number Information
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NPI Number | 1922083898
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Entity Type | Individual
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Provider Name | JOHN CHARLES GERANCHER III MD
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Gender | Male
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 11/14/2023
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Provider Practice Location Address
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Address Line | 3331 HEALY DR #26851
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City | WINSTON SALEM
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State | NC
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Zip | 27103-1407
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Country | US
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Telephone | 336-408-1036
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 26851
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City | WINSTON SALEM
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State | NC
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Zip | 27114-6851
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Country | US
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Telephone |
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 9500077
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 9500077
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License Number State | NC
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