MEDICARE: VILMARIE J TANON MD

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	208000000X	Pediatrics Physician	020746	PR
2	208000000X	Pediatrics Physician	50494	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50494	OTHER	TN	STATE LICENSE
2	020746	OTHER	PR	MEDICAL LICENSE

General Provider Information

NPI Number	:	1932454097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VILMARIE J TANON MD

Provider Business Mailing Address
First Line	:	739 PRESIDENT PL STE 110
Second Line	:
City	:	SMYRNA
State	:	TN
Zip	:	37167-6845
Country	:	US
Telephone Number	:	615-625-7780
Fax Number	:	615-625-7781

Provider Business Practice Location Address
First Line	:	739 PRESIDENT PL STE 110
Second Line	:
City	:	SMYRNA
State	:	TN
Zip	:	37167-6845
Country	:	US
Telephone Number	:	615-628-7780
Fax Number	:	615-625-7781

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

Provider Enumeration Date	:	07/16/2012
Last Update Date	:	02/27/2018

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Directions to “ VILMARIE J TANON MD” Practice Location

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