Individual
JAMES MICHAEL GANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7300 S RAEFORD RD, FAYETTEVILLE, NC 28304-6162
(910) 488-2120
Mailing address
213 IVEY GATE LN, GARNER, NC 27529-7528
(440) 429-2624
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
253692
NY
2085R0202X
Diagnostic Radiology Physician
Primary
2018-00911
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03033185
—
NY
Enumeration date
05/14/2007
Last updated
09/22/2020
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