Individual
DR. WILLIAM GORDON TANNER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
721 WELLNESS WAY, STE 100, LAWRENCEVILLE, GA 30046-3304
(770) 995-7989
(770) 339-8646
Mailing address
721 WELLNESS WAY, STE 100, LAWRENCEVILLE, GA 30046-3304
(770) 995-7989
(770) 339-8646
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
046817
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00828396B
—
GA
01
—
100014260
RAIL ROAD MEDICARE
GA
01
—
29-00016
UNITED HEALTH CARE
GA
01
—
52237427
BLUE CROSS BLUE SHIELD
GA
01
—
582061514007
PRUDENTIAL
GA
01
—
7231009
MANAGE CARE
GA
01
—
8485
ONE HEALTH
GA
Enumeration date
09/06/2005
Last updated
09/25/2012
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