Individual
NICHOLAS HENRY TANNENBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2817 ROCK MERRITT AVE, FORT BRAGG, NC 28310-0004
(910) 907-8922
(910) 907-6069
Mailing address
2817 ROCK MERRITT AVE, FORT BRAGG, NC 28310-0001
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
12918
GA
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
2024-01464
NC
Other
Enumeration date
06/07/2021
Last updated
01/30/2026
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