Provider Demographics
NPI:1982093902
Name:GANN, JAMIE MATHIS (PA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MATHIS
Last Name:GANN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:JEAN
Other - Last Name:MATHIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 529
Mailing Address - Street 2:
Mailing Address - City:ROYSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30662-0529
Mailing Address - Country:US
Mailing Address - Phone:706-621-7561
Mailing Address - Fax:706-621-7557
Practice Address - Street 1:1061 DOWDY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5700
Practice Address - Country:US
Practice Address - Phone:706-621-7575
Practice Address - Fax:706-621-7557
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7459363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical