Healthcare Provider Details

I. General information

NPI: 1710515184
Provider Name (Legal Business Name): TANNER ONCOLOGY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 CLINIC AVE STE 202
CARROLLTON GA
30117-4454
US

IV. Provider business mailing address

100 GREENWAY BLVD FL 2
CARROLLTON GA
30117-4338
US

V. Phone/Fax

Practice location:
  • Phone: 770-333-2220
  • Fax: 678-581-7180
Mailing address:
  • Phone: 770-838-8710
  • Fax: 770-812-5735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: CLINT HOFFMAN
Title or Position: SR. VP OF OPERATIONS
Credential:
Phone: 770-838-8302