Provider Demographics
NPI:1710913090
Name:DEFRANCO, GINA MARIE (DO)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:DEFRANCO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:ZULANDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:HARROGATE
Mailing Address - State:TN
Mailing Address - Zip Code:37752-0367
Mailing Address - Country:US
Mailing Address - Phone:423-865-7193
Mailing Address - Fax:423-869-7195
Practice Address - Street 1:424 N. BROAD STREET
Practice Address - Street 2:
Practice Address - City:NEW TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37752
Practice Address - Country:US
Practice Address - Phone:423-869-7193
Practice Address - Fax:423-869-7195
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1642207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3329756Medicare PIN
TNI29154Medicare UPIN