Provider Demographics
NPI:1003855537
Name:GANNON, CAROLINE L (DPM)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:L
Last Name:GANNON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:100 COVEY DR
Practice Address - Street 2:SUITE 309
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5665
Practice Address - Country:US
Practice Address - Phone:615-790-3323
Practice Address - Fax:615-790-6331
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM0000000632213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6089017OtherBCBS
TN3354139Medicaid
V05173Medicare UPIN
3730128Medicare PIN