Organization
JOHN FANNING, PH.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN TRUMAN FANNING PHD (CLINICAL NEUROPSYCHOLOGIST)
(504) 421-0730
Entity
Organization
Contact information
Practice address
4440 CANAL ST, NEW ORLEANS, LA 70119-5947
(504) 421-0730
Mailing address
715 PECAN GROVE LN, JEFFERSON, LA 70121-1130
(504) 421-0730
(888) 959-6762
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
PSYCHOLOGY 468
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1552836
—
LA
Enumeration date
09/13/2016
Last updated
09/13/2016
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