Individual
MR. JACK ELLIS TANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPHR
Contact information
Practice address
1206 CRAWFORD ST, AMERICUS, GA 31709-3277
(229) 931-0271
(229) 931-9864
Mailing address
PO BOX 285, 122 WEST COLLEGE ST, ELLAVILLE, GA 31806-0285
(229) 937-9105
(229) 931-9864
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
013950
GA
Other
Enumeration date
10/06/2006
Last updated
07/08/2007
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