Provider Demographics
NPI:1174795629
Name:ANN R. GORANSON D.P.M.
Entity type:Organization
Organization Name:ANN R. GORANSON D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GORANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:931-381-3020
Mailing Address - Street 1:1413 HATCHER LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3535
Mailing Address - Country:US
Mailing Address - Phone:931-381-3020
Mailing Address - Fax:
Practice Address - Street 1:1413 HATCHER LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3535
Practice Address - Country:US
Practice Address - Phone:931-381-3020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM-368213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5697630001Medicare NSC