Provider Demographics
NPI:1376888313
Name:GANTT, JOHN ARTHUR (PA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ARTHUR
Last Name:GANTT
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:23095 DUCK POND CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560
Mailing Address - Country:US
Mailing Address - Phone:919-303-4777
Mailing Address - Fax:919-303-0077
Practice Address - Street 1:2046 CREEKSIDE LANDING DR
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3982
Practice Address - Country:US
Practice Address - Phone:919-303-4777
Practice Address - Fax:919-303-0077
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
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Provider Licenses
StateLicense IDTaxonomies
NC0010-03770363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical