Organization
COFFEE FAMILY MEDICINE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LYDIA TANNER M.D. (PHYSICIAN)
(912) 384-2353
Entity
Organization
Contact information
Practice address
200 DOCTORS DR, SUITE 224, DOUGLAS, GA 31533-2201
(912) 384-2353
Mailing address
200 DOCTORS DR, SUITE 224, DOUGLAS, GA 31533-2201
(912) 384-2353
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
53885
GA
363A00000X
Physician Assistant
004691
GA
Other
Enumeration date
07/27/2006
Last updated
01/19/2012
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