Healthcare Provider Details

I. General information

NPI: 1538193438
Provider Name (Legal Business Name): ERINN L GARDNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERINN L TUCK MD

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 OLD BALL GROUND HWY SUITE B
CANTON GA
30114-2890
US

IV. Provider business mailing address

8200 ROBERTS DR STE 450
SANDY SPRINGS GA
30350-4115
US

V. Phone/Fax

Practice location:
  • Phone: 770-953-3331
  • Fax: 770-720-8211
Mailing address:
  • Phone: 770-952-8612
  • Fax: 678-803-6944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number59413
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: