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Organization

DOUGLAS MEDICAL SPECIALIST

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MARSHALL G TANNER M.D. (DIRECTOR)
(912) 384-3338
Entity
Organization

Contact information

Practice address
134 E FLEETWOOD AVE, WILLACOOCHEE, GA 31650
(912) 384-3338
(912) 383-6365
Mailing address
134 E FLEETWOOD AVE, WILLACOOCHEE, GA 31650
(912) 384-3338
(912) 383-6365

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
056658
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1225021678
NPI
GA
01
1326031865
NPI
GA
01
1750374294
NPI
GA
01
1891815924
NPI
GA
Enumeration date
09/25/2007
Last updated
10/30/2007
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