# TANNER MEDICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** West Georgia Urology Associates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043909302
- **Authorized official:** CLINT HOFFMAN (SENIOR VP TMG OPERATIONS)
- **Authorized official phone:** (770) 838-8302

## Contact information

- **Practice address:** 150 CLINIC AVE STE 202, CARROLLTON, GA 30117-4402
- **Practice address phone:** (770) 834-6988
- **Practice address fax:** (770) 834-1090
- **Mailing address:** 100 GREENWAY BLVD FL 2, CARROLLTON, GA 30117-4338
- **Mailing address phone:** (770) 838-8710

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | — | NULL | Yes |

## Other

- **Enumeration date:** 05/03/2023
- **Last updated:** 02/29/2024