Provider Demographics
NPI:1003831900
Name:GANN, G DWAYNE (R,MR)
Entity Type:Individual
Prefix:MR
First Name:G
Middle Name:DWAYNE
Last Name:GANN
Suffix:
Gender:M
Credentials:R,MR
Other - Prefix:
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Mailing Address - Street 1:1804 WOODALL RD SW
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-4314
Mailing Address - Country:US
Mailing Address - Phone:256-306-0554
Mailing Address - Fax:
Practice Address - Street 1:1201 13TH AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4300
Practice Address - Country:US
Practice Address - Phone:256-350-7779
Practice Address - Fax:256-350-2272
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
259436247100000X, 2471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Not Answered2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging