Organization
PRO-MED OF ATLANTA, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUSAN TANNER M.D. (MEDICAL DOCTOR)
(770) 676-6000
Entity
Organization
Contact information
Practice address
4646 NORTH SHALLOWFORD ROAD, #400, ATLANTA, GA 30338
(770) 676-6000
(770) 392-9805
Mailing address
4646 N SHALLOWFORD RD, #400, ATLANTA, GA 30338-6308
(770) 676-6000
(770) 392-9805
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
AT2218116
GA
208D00000X
General Practice Physician
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Other
Enumeration date
07/10/2010
Last updated
07/10/2010
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