Provider Demographics
NPI:1730446394
Name:FANN, JOSHUA RYAN (CP)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:RYAN
Last Name:FANN
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 E 72ND ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4917
Mailing Address - Country:US
Mailing Address - Phone:912-344-9599
Mailing Address - Fax:912-335-3435
Practice Address - Street 1:918 E 72ND ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4917
Practice Address - Country:US
Practice Address - Phone:912-344-9599
Practice Address - Fax:912-335-3435
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA57224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist