Active NPI
Mary Tanner, M.D.
- Pediatric Infectious Diseases Physician
- Atlanta, GA
National Provider Identifier
1174751549
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Infectious Diseases Physician
- License
- 2011009937
- Practice address
- 1600 Clifton Rd NE
Atlanta, GA 30329 - Phone
- (404) 639-3311
- NPI assigned
- Jun 24, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Infectious Diseases Physician | 2080P0208X | 2011009937 | MO | Primary |
Addresses
Primary practice location
1600 Clifton Rd NE
Atlanta, GA 30329
Mailing address
259 Lake Ruby Dr
Suwanee, GA 30024-2399
Phone (816) 509-8082
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130524000057 | TN | Order and Referring Only - Pediatric Medicine | 1052559457 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2011009937 | MO | MD | Pediatric Infectious Diseases Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245801600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1527379200000",
"number": "1174751549",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "259 LAKE RUBY DR",
"city": "SUWANEE",
"state": "GA",
"postal_code": "300242399",
"telephone_number": "816-509-8082"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 CLIFTON RD NE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "30329",
"telephone_number": "404-639-3311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TANNER",
"first_name": "MARY",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-06-24",
"last_updated": "2018-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "2080P0208X",
"taxonomy_group": "",
"desc": "Pediatrics, Pediatric Infectious Diseases",
"state": "MO",
"license": "2011009937",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.