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General NPI Number Information
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NPI Number | 1992093579
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Entity Type | Individual
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Provider Name | MARTI M GANTT PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/15/2011
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Last Update Date | 09/25/2018
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Provider Practice Location Address
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Address Line | 3200 W HIGHWAY 22
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City | CORSICANA
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State | TX
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Zip | 75110-2449
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Country | US
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Telephone | 903-875-2188
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Fax | 903-875-2186
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Provider Business Mailing Address
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Address Line | PO BOX 368
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City | CORSICANA
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State | TX
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Zip | 75151-0368
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Country | US
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Telephone | 903-875-2188
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Fax | 903-875-2186
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA07344
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License Number State | TX
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