# PRO-MED OF ATLANTA, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730491473
- **Authorized official:** DR. SUSAN TANNER M.D. (MEDICAL DOCTOR)
- **Authorized official phone:** (770) 676-6000

## Contact information

- **Practice address:** 4646 NORTH SHALLOWFORD ROAD, \#400, ATLANTA, GA 30338
- **Practice address phone:** (770) 676-6000
- **Practice address fax:** (770) 392-9805
- **Mailing address:** 4646 N SHALLOWFORD RD, \#400, ATLANTA, GA 30338-6308
- **Mailing address phone:** (770) 676-6000
- **Mailing address fax:** (770) 392-9805

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | AT2218116 | GA | Yes |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |

## Other

- **Enumeration date:** 07/10/2010
- **Last updated:** 07/10/2010