Organization
ROBERT A. GANNAWAY, M.D., PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT A. GANNAWAY M.D. (PHYSICIAN)
(601) 892-7860
Entity
Organization
Contact information
Practice address
408 E RAILROAD AVE, SUITE B, CRYSTAL SPRINGS, MS 39059-2520
(601) 892-7860
(601) 892-7861
Mailing address
408 E RAILROAD AVE, SUITE B, CRYSTAL SPRINGS, MS 39059-2520
(601) 892-7860
(601) 892-7861
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12331
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01529794
—
MS
Enumeration date
07/11/2006
Last updated
08/22/2020
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