Provider Demographics
NPI:1780776286
Name:GANNAWAY, WILLIAM CHRISTOPHER (M D)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHRISTOPHER
Last Name:GANNAWAY
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 GOSS RD SW
Mailing Address - Street 2:FOX ARMY HEALTH CLINIC
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35809-0001
Mailing Address - Country:US
Mailing Address - Phone:256-955-8888
Mailing Address - Fax:256-876-3333
Practice Address - Street 1:4100 GOSS RD SW
Practice Address - Street 2:FOX ARMY HEALTH CLINIC
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35809-0001
Practice Address - Country:US
Practice Address - Phone:256-955-8888
Practice Address - Fax:256-876-3333
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00024964207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000012072OtherBLUE CROSS BLUE SHIELD
AL000012072Medicaid
AL5281679OtherAETNA
AL5281679OtherAETNA
AL51512072Medicare ID - Type Unspecified