Individual
MRS. TABETHA BROOME RENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-AC
Contact information
Practice address
400 CHARTER BLVD, MACON, GA 31210-4831
(478) 746-7577
Mailing address
PO BOX 2564, MACON, GA 31203-2565
(478) 746-5644
(478) 745-4849
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
05414
GA
367H00000X
Anesthesiologist Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
578310
WELLCARE
GA
01
—
580628385
TRICARE
GA
05
—
606097755D
—
GA
05
—
606097755E
—
GA
05
—
606097755F
—
GA
05
—
606097755G
—
GA
01
—
P01101055
RAILROAD MEDICARE
GA
Enumeration date
08/07/2008
Last updated
04/13/2022
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us