Provider Demographics
NPI:1356865489
Name:GANN, LINNEA ANITA
Entity type:Individual
Prefix:
First Name:LINNEA
Middle Name:ANITA
Last Name:GANN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 772294
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-2294
Mailing Address - Country:US
Mailing Address - Phone:847-504-5000
Mailing Address - Fax:
Practice Address - Street 1:1118 MORNINGSIDE DR STE A
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2906
Practice Address - Country:US
Practice Address - Phone:478-218-1420
Practice Address - Fax:478-218-1423
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001466213E00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty