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General NPI Number Information
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NPI Number | 1629869508
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Entity Type | Individual
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Provider Name | TANNER BOYLE PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 2701 US HIGHWAY 17 STE 1B
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City | RICHMOND HILL
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State | GA
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Zip | 31324-3863
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Country | US
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Telephone | 912-727-7546
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Fax | 912-445-2960
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Provider Business Mailing Address
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Address Line | 2400 BELLEVUE RD STE 21A
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City | DUBLIN
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State | GA
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Zip | 31021-2890
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Country | US
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Telephone | 478-328-0281
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Fax | 478-328-1433
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 12985
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License Number State | GA
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