Individual
ANGELA GANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 TARPON TRL, JACKSONVILLE, NC 28546-5287
(910) 938-1114
(910) 938-1118
Mailing address
200 TARPON TRL, JACKSONVILLE, NC 28546-5287
(910) 938-1114
(910) 938-1118
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
092762
OH
2084P0800X
Psychiatry Physician
Primary
2018-00436
NC
2084P0800X
Psychiatry Physician
258681
NY
Other
Enumeration date
05/30/2007
Last updated
10/14/2019
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