Provider Demographics
NPI:1861666893
Name:GANA CORPORATION
Entity Type:Organization
Organization Name:GANA CORPORATION
Other - Org Name:DR. MITCHELL R. GANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:R
Authorized Official - Last Name:GANA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-792-3383
Mailing Address - Street 1:1301 SHILOH RD NW
Mailing Address - Street 2:SUITE 1440
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7147
Mailing Address - Country:US
Mailing Address - Phone:770-792-3383
Mailing Address - Fax:770-792-2425
Practice Address - Street 1:1301 SHILOH RD NW
Practice Address - Street 2:SUITE 1440
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7147
Practice Address - Country:US
Practice Address - Phone:770-792-3383
Practice Address - Fax:770-792-2425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007683111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCJBQOtherMEDICARE PROVIDER#
GAV03747Medicare UPIN