Angela Gannon, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

2018-00436 Issued in NC

Practice address

200 Tarpon TRL
Jacksonville, NC 28546-5287

Phone

(910) 938-1114

Fax

(910) 938-1118

NPI assigned

May 30, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Angela Smith Former name

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Coastal Carolina Neuropsychiatric Center, PA

  • Psychiatry Physician
  • Jacksonville, NC
  • NPI 1184737462
  Medicare reassignment NPD
• Garner Behavioral Hospital, LLC

  dba Raleigh Oaks Behavioral Health

  • Adult Mental Health Clinic/Center
  • Garner, NC
  • NPI 1548049679
  Medicare reassignment NPD
• Chautauqua Co. Chapter of Nysarc Inc Dba the Resource Center

  dba The Resource Center

  • Multi-Specialty Clinic/Center
  • Jamestown, NY
  • NPI 1982682639
  NPD (past)
• Chautauqua County Chapter of Nysarc Inc

  dba The Resource Center

  • Long Term Care Pharmacy
  • Jamestown, NY
  • NPI 1427095892
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571011200000",
    "number": "1740481431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 TARPON TRL",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285465287",
            "telephone_number": "910-938-1114",
            "fax_number": "910-938-1118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 TARPON TRL",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285465287",
            "telephone_number": "910-938-1114",
            "fax_number": "910-938-1118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANNON",
        "first_name": "ANGELA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-30",
        "last_updated": "2019-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "258681",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OH",
            "license": "092762",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "2018-00436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "SMITH",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Taylor Shea Gaffney, PHARMD
• Mary Kathleen Galbraith
• Eric Shannon Gallagher
• Amanda Renee Wells Galluppi, PA-C
• Bailey Margaret Galvin, DPT, PT
• James C Gant, M.D., F.A.A.P.
• Sandy Gant, MS, OTR/L
• Sara M Gant, LCMHC-A
• Peter Ganun, CRNA
• Evelin Garcia Lopez

• Psychiatry Physician in Jacksonville, NC
• Providers in Jacksonville, NC by specialty
• Psychiatry Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.