Individual
LAKEN RENEE TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPAP, PA-C
Contact information
Practice address
1900 TEBEAU ST, WAYCROSS, GA 31501-6357
(912) 283-3030
Mailing address
99 RUFUS RD, WILLACOOCHEE, GA 31650-5400
(912) 327-0659
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
11382
GA
Other
Enumeration date
02/07/2023
Last updated
02/07/2023
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