Active NPI
Jerry Swindell Ganus Jr.
- Peer Specialist
- Raeford, NC
National Provider Identifier
1972396463
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 2024-9570-01
- Practice address
- 402 Harris Ave
Raeford, NC 28376-3112 - Phone
- (910) 875-5590
- Fax
- (910) 875-5008
- NPI assigned
- May 27, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 2024-9570-01 | NC | Primary |
Addresses
Primary practice location
402 Harris Ave
Raeford, NC 28376-3112
Mailing address
690 Wiltshire Rd
Fayetteville, NC 28314-0743
Phone (704) 219-4483
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2024-9570-01 | NC | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1748304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1748304000000",
"number": "1972396463",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "690 WILTSHIRE RD",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283140743",
"telephone_number": "704-219-4483"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "402 HARRIS AVE",
"city": "RAEFORD",
"state": "NC",
"postal_code": "283763112",
"telephone_number": "910-875-5590",
"fax_number": "910-875-5008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANUS",
"first_name": "JERRY",
"middle_name": "SWINDELL",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-05-27",
"last_updated": "2025-05-27",
"certification_date": "2025-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "NC",
"license": "2024-9570-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raeford, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.