Individual
PICKENS A. GANTT II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
830 PENNSYLVANIA AVE, SUITE 205, CHARLESTON, WV 25302-3302
(304) 388-2863
(304) 388-2866
Mailing address
830 PENNSYLVANIA AVE, SUITE 205, CHARLESTON, WV 25302
(304) 388-2863
(304) 388-2866
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
13100
TN
207VE0102X
Reproductive Endocrinology Physician
Primary
22945
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810010685
—
WV
Enumeration date
09/20/2006
Last updated
12/14/2015
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