Individual
MRS. JENNIFER HADDEN TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1067 PEACHTREE ST, LOUISVILLE, GA 30434-1558
(478) 625-7000
Mailing address
1067 PEACHTREE ST, LOUISVILLE, GA 30434-1558
(478) 625-7000
(478) 625-8907
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004764
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
044692615A
—
GA
Enumeration date
09/25/2006
Last updated
09/28/2018
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