Basic Information
| Provider Information | |||||||||
| NPI: | 1710515184 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TANNER ONCOLOGY SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 706 DIXIE ST STE 220 | ||||||||
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| City: | CARROLLTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301173819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708388710 | ||||||||
| FaxNumber: | 7708125735 | ||||||||
| Practice Location | |||||||||
| Address1: | 157 CLINIC AVE STE 202 | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301174454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703332220 | ||||||||
| FaxNumber: | 6785817180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2020 | ||||||||
| LastUpdateDate: | 03/31/2020 | ||||||||
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| AuthorizedOfficialLastName: | FOX | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR. VP OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 7708388302 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
No ID Information.