Provider Demographics
NPI:1144029380
Name:GANTT, GREGORY
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:GANTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 E RICH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2131
Mailing Address - Country:US
Mailing Address - Phone:234-571-6054
Mailing Address - Fax:
Practice Address - Street 1:1555 E RICH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2131
Practice Address - Country:US
Practice Address - Phone:234-571-6054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health