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General NPI Number Information
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NPI Number | 1083224240
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Entity Type | Organization
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Legal Business Name | SUSAN TANNER TANNER HEALTHCARE SERVICES, LLC
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Dates
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Enumeration Date | 08/03/2020
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 546 LONG PINE DRIVE
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City | BYTHEWOOD
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State | SC
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Zip | 29016
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Country | US
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Telephone | 302-399-6509
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Fax | 803-708-3743
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Provider Business Mailing Address
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Address Line | 546 LONG PINE DR
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City | BLYTHEWOOD
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State | SC
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Zip | 29016-7298
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Country | US
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Telephone | 302-399-6509
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Fax | 803-708-3743
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Authorized Official
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Title or Position | OWNER
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Name | SUSAN TANNER
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Credential | NP
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Telephone | 302-399-6509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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