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General NPI Number Information
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NPI Number | 1770391047
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Entity Type | Organization
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Legal Business Name | TANNER BRIDGE CLINIC INC
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 1480 S HIGHWAY 27 STE B
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City | CARROLLTON
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State | GA
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Zip | 30117-8901
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Country | US
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Telephone | 770-812-5900
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Fax | 770-812-5584
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Provider Business Mailing Address
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Address Line | 100 GREENWAY BLVD BOX C
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City | CARROLLTON
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State | GA
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Zip | 30117-4358
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Country | US
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Telephone | 770-838-8710
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Fax | 770-812-5735
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Authorized Official
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Title or Position | SENIOR VP TANNER MEDICAL GROUP
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Name | CLINT HOFFMAN
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Credential |
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Telephone | 770-812-5304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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