Provider Demographics
NPI:1225846793
Name:GUNN, IMANI SARAN
Entity type:Individual
Prefix:
First Name:IMANI
Middle Name:SARAN
Last Name:GUNN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7450 US HIGHWAY 21
Mailing Address - Street 2:
Mailing Address - City:PORT WENTWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-1145
Mailing Address - Country:US
Mailing Address - Phone:912-419-0333
Mailing Address - Fax:
Practice Address - Street 1:7450 GA HIGHWAY 21 UNIT 912
Practice Address - Street 2:
Practice Address - City:PORT WENTWORTH
Practice Address - State:GA
Practice Address - Zip Code:31407-1145
Practice Address - Country:US
Practice Address - Phone:912-419-0333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
102X00000X, 103K00000X, 302F00000X, 374K00000X, 374J00000X, 101Y00000X, 374T00000X, 390200000X
GA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program