| John Fanning, Ph.d. | |
|
4440 Canal St New Orleans LA 70119-5947 | |
| (504) 421-0730 | |
| Not Available |
| Full Name | John Fanning, Ph.d. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 4440 Canal St, New Orleans, Louisiana |
| Authorized Official Name and Position | John Truman Fanning (CLINICAL NEUROPSYCHOLOGIST) |
| Authorized Official Contact | 5044210730 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| John Fanning, Ph.d. 715 Pecan Grove Ln Jefferson LA 70121-1130 Ph: (504) 421-0730 | John Fanning, Ph.d. 4440 Canal St New Orleans LA 70119-5947 Ph: (504) 421-0730 |
| NPI Number | 1033667563 |
|---|---|
| Provider Enumeration Date | 09/13/2016 |
| Last Update Date | 09/13/2016 |
| Medicare PECOS PAC ID | 9638434178 |
|---|---|
| Medicare Enrollment ID | O20180604000487 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033667563 | NPI | - | NPPES |
| 1552836 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | PSYCHOLOGY 468 (Louisiana) | Primary |
| Provider Name | John T. Fanning |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1508072216 PECOS PAC ID: 5496918732 Enrollment ID: I20120924000689 |
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