MEDICARE: DR. TANNA LIM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	055071	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720015084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TANNA LIM M.D.

Provider Business Mailing Address
First Line	:	303 PARKWAY DR NE
Second Line	:	DEPT OF GME
City	:	ATLANTA
State	:	GA
Zip	:	30312-1212
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	285 BOULEVARD NE
Second Line	:	SUITE 525
City	:	ATLANTA
State	:	GA
Zip	:	30312-4205
Country	:	US
Telephone Number	:	404-265-1044
Fax Number	:	404-265-1047

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	10/02/2013

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