MEDICARE: TMC TANNER GYNECOLOGY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1992710750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TMC TANNER GYNECOLOGY INC

Provider Business Mailing Address
First Line	:	119 AMBULANCE DR
Second Line	:	SUITE 202
City	:	CARROLLTON
State	:	GA
Zip	:	30117-3857
Country	:	US
Telephone Number	:
Fax Number	:	770-838-8922

Provider Business Practice Location Address
First Line	:	690 DALLAS HWY
Second Line	:	SUITE 301
City	:	VILLA RICA
State	:	GA
Zip	:	30180-1264
Country	:	US
Telephone Number	:	770-456-3850
Fax Number	:	770-456-3826

Authorized Official
Title or Position	:	CFO
Name	:	DEBBI MACALUSO-PEARE
Credential	:
Telephone Number	:	770-838-8554

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	05/14/2008

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