Provider Demographics
NPI:1861496853
Name:GANIME, CHARLES D (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:D
Last Name:GANIME
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 HOSPITAL RD
Mailing Address - Street 2:STE I
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2495
Mailing Address - Country:US
Mailing Address - Phone:931-968-9191
Mailing Address - Fax:931-968-9081
Practice Address - Street 1:155 HOSPITAL RD
Practice Address - Street 2:STE I
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2495
Practice Address - Country:US
Practice Address - Phone:931-968-9191
Practice Address - Fax:931-968-9081
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM0000000591213E00000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4043822OtherBCBS PROVIDER NUMBER
TN2740157OtherUNITED HEALTHCARE PROV. #
TN7641364OtherAETNA PROVIDER NUMBER
TN3353680Medicaid
TNU91929Medicare UPIN
TN3353680Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
TN4736190001Medicare NSC