Individual
MICHAEL TANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
5763 VILLAGE LOOP, FAIRBURN, GA 30213-4641
(770) 377-1563
Mailing address
5763 VILLAGE LOOP, FAIRBURN, GA 30213-4641
(770) 377-1563
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
LMFT001813
GA
Other
Enumeration date
10/24/2020
Last updated
10/24/2020
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