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Individual

CHARLIE MURPHY GANTT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
NP, AGPRN, PMHNP

Contact information

Practice address
32905 W 12 MILE RD, FARMINGTON HILLS, MI 48334-3342
(248) 957-9184
(248) 957-9185
Mailing address
1922 FOREST VIEW CT, COMMERCE TOWNSHIP, MI 48390-3943
(248) 762-8017

Taxonomy

Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
4704317868
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4704317868
MI
363LP2300X
Primary Care Nurse Practitioner
4704317868
MI

Other

Enumeration date
04/29/2020
Last updated
05/08/2024
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