Individual
MRS. TONJA A GANTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N. P.
Contact information
Practice address
716 OLD CHEROKEE RD, LEXINGTON, SC 29072-9406
(803) 359-2273
Mailing address
716 OLD CHEROKEE RD, LEXINGTON, SC 29072-9406
(803) 359-2273
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
APN2136
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP0889
—
SC
Enumeration date
08/12/2005
Last updated
10/10/2014
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