Robert a. Gannaway, M.D., PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

12331 Issued in MS

Legal business name

ROBERT A. GANNAWAY, M.D., PLLC

Practice address

408 E Railroad Ave
Suite B
Crystal Springs, MS 39059-2520

Phone

(601) 892-7860

Fax

(601) 892-7861

NPI assigned

Jul 11, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Robert A. Gannaway, M.D.

Title

Physician

Phone

(601) 892-7860

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942234117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 E RAILROAD AVE",
            "address_2": "SUITE B",
            "city": "CRYSTAL SPRINGS",
            "state": "MS",
            "postal_code": "390592520",
            "telephone_number": "601-892-7860",
            "fax_number": "601-892-7861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 E RAILROAD AVE",
            "address_2": "SUITE B",
            "city": "CRYSTAL SPRINGS",
            "state": "MS",
            "postal_code": "390592520",
            "telephone_number": "601-892-7860",
            "fax_number": "601-892-7861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT A. GANNAWAY, M.D., PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GANNAWAY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "601-892-7860",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "12331",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01529794",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.