Individual
DR. MARY TANEOUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1350 WALTON WAY, AUGUSTA, GA 30901-2612
(706) 774-5400
(706) 774-5096
Mailing address
14275 MIDWAY RD, SUITE 400, ADDISON, TX 75001-3614
(317) 275-8000
(610) 271-4245
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
000346
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52212128
BCBS
GA
01
—
58-1446543-001
TRICARE
GA
05
—
838631566A
—
GA
Enumeration date
03/02/2006
Last updated
07/06/2015
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