Organization
TANNER MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLINT HOFFMAN (SR VP)
(770) 812-8845
Entity
Organization
Contact information
Practice address
100 GREENWAY BLVD FL 2, CARROLLTON, GA 30117-4338
(770) 838-8710
(770) 812-5735
Mailing address
100 GREENWAY BLVD FL 2, CARROLLTON, GA 30117-4338
(770) 838-8710
(770) 812-5735
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
207RG0100X
Gastroenterology Physician
—
—
207RI0011X
Interventional Cardiology Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
2084N0400X
Neurology Physician
—
—
2084P0800X
Psychiatry Physician
—
—
2086S0129X
Vascular Surgery Physician
—
GA
208D00000X
General Practice Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202G707301
MEDICARE PTAN
GA
Enumeration date
05/13/2009
Last updated
02/29/2024
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