MEDICARE: ALLISON SHANNON GANUS MCD CCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP006645	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	52205907	OTHER	GA	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043365141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON SHANNON GANUS MCD CCC

Provider Business Mailing Address
First Line	:	2424 DOUBLE CHURCHES RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-2741
Country	:	US
Telephone Number	:	706-324-6112
Fax Number	:	706-596-8259

Provider Business Practice Location Address
First Line	:	2424 DOUBLE CHURCHES RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-2741
Country	:	US
Telephone Number	:	706-324-6112
Fax Number	:	706-596-8259

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	06/03/2011

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