=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730454703
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TANNER CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2012
-----------------------------------------------------
Last Update Date | 03/09/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8737 DUNWOODY PL SUITE 1
-----------------------------------------------------
City | SANDY SPRINGS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30350-2985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-552-3282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8737 DUNWOODY PL SUITE 1
-----------------------------------------------------
City | SANDY SPRINGS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30350-2985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-552-3282
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | WILLIAM GEOFFREY TANNER
-----------------------------------------------------
Credential | D. C.
-----------------------------------------------------
Telephone | 770-552-3282
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIR006491
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------