Provider Demographics
NPI:1871772590
Name:GANTT, TAMMY (CRT)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:GANTT
Suffix:
Gender:F
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 BUCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:27525-8042
Mailing Address - Country:US
Mailing Address - Phone:919-602-3303
Mailing Address - Fax:
Practice Address - Street 1:45 BUCKINGHAM DR
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:NC
Practice Address - Zip Code:27525-8042
Practice Address - Country:US
Practice Address - Phone:919-602-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA4707227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC561924070OtherTAX ID
NC012AGOtherBCBS OF NC