Individual
MR. CHARLES RAY TANNER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
P.A.-C.
Contact information
Practice address
900 E OAK HILL AVE, KNOXVILLE, TN 37917-4522
(865) 545-8000
Mailing address
PO BOX 5044, OAK RIDGE, TN 37831-5044
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1331
TN
363A00000X
Physician Assistant
MT1404742
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
BLUE CROSS
TN
Enumeration date
05/25/2006
Last updated
07/08/2007
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