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General NPI Number Information
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NPI Number | 1770778342
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Entity Type | Organization
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Legal Business Name | TARHEEL SURGICAL SPECIALISTS, LLC
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Dates
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Enumeration Date | 09/07/2007
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Last Update Date | 09/07/2007
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Provider Practice Location Address
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Address Line | 310 S. MCCASKEY RD.
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City | WILLIAMSTON
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State | NC
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Zip | 27892-1128
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Country | US
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Telephone | 252-799-3006
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Fax | 252-799-0955
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Provider Business Mailing Address
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Address Line | 310 S. MCCASKEY RD.
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City | WILLIAMSTON
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State | NC
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Zip | 27892-1128
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Country | US
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Telephone | 252-799-3006
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Fax | 252-799-0955
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. TODD FITZGERALD TANNER
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Credential | MD
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Telephone | 252-799-3006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 9800713
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License Number State | NC
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