Dr Brian Scott Gannon, MD | |
850 Peter Bryce Blvd, Tuscaloosa, AL 35401-7419 | |
(205) 348-1304 | |
(205) 348-7988 |
Full Name | Dr Brian Scott Gannon |
---|---|
Gender | Male |
Speciality | Pediatrics |
Location | 850 Peter Bryce Blvd, Tuscaloosa, Alabama |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1912992678 | NPI | - | NPPES |
3830971 | Medicaid | TN | |
64122582 | Medicaid | KY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 40582 (Kentucky) | Secondary |
208000000X | Pediatrics | MD30442 (Tennessee) | Secondary |
208000000X | Pediatrics | 32891 (Alabama) | Primary |
Entity Name | Capstone Health Services Foundation Pc |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1740397751 PECOS PAC ID: 6103724489 Enrollment ID: O20040330001160 |
Mailing Address | Practice Location Address |
---|---|
Dr Brian Scott Gannon, MD 850 Peter Bryce Blvd, Tuscaloosa, AL 35401-7419 Ph: (205) 348-1304 | Dr Brian Scott Gannon, MD 850 Peter Bryce Blvd, Tuscaloosa, AL 35401-7419 Ph: (205) 348-1304 |
Elizabeth Cockrum, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 850 5th Ave E, Tuscaloosa, AL 35401 Phone: 205-348-1770 Fax: 205-348-7988 | |
Robert Miller Wright, Pediatrics Medicare: Medicare Enrolled Practice Location: 850 Peter Bryce Blvd, Tuscaloosa, AL 35401 Phone: 205-348-1770 | |
Keisha Gibson Lowther, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 6531 Highway 69 S, Suite A, Tuscaloosa, AL 35405 Phone: 205-343-6979 | |
Courtney Gladwell, CPNP-PC Pediatrics Medicare: Medicare Enrolled Practice Location: 4700 Rice Mine Rd Ne, Tuscaloosa, AL 35406 Phone: 205-614-5628 | |
Raghda Yahya, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1060 Fairfax Park, Ste B, Tuscaloosa, AL 35406 Phone: 205-758-6471 Fax: 205-758-6472 | |
Hanseek Choi, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 1820 Rice Mine Rd N, Suite 200, Tuscaloosa, AL 35406 Phone: 205-333-4656 Fax: 205-333-4660 | |
Dr. Denise N Brown, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 4880 Harkey Ln, Tuscaloosa, AL 35406 Phone: 205-333-8222 Fax: 205-333-8233 |