Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | DPM0000000632 | TN |
NPI | 1003855537 |
---|---|
Provider Name | Dr. Caroline L Gannon |
First Address | Goodlettsville, TN 37072-3132 |
Second Address | Franklin, TN 37067-5665 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 19/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3354139 | (05) | TN |
6089017 | BCBS (01) | TN |
V05173 | (02) |