NPIMap

Individual provider Active NPI

Jennifer Hadden Tanner, PA-C

  • Physician Assistant
  • Louisville, GA
National Provider Identifier
1710087101
Registry record updated Sep 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
004764 Issued in GA
Practice address
1067 Peachtree St
Louisville, GA 30434-1558
Phone
(478) 625-7000
NPI assigned
Sep 25, 2006
Last updated
Sep 28, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 004764 GA Primary

Addresses

Primary practice location

1067 Peachtree St
Louisville, GA 30434-1558

Mailing address

1067 Peachtree St
Louisville, GA 30434-1558
Phone (478) 625-7000

Other identifiers 1

IdentifierTypeStateIssuer
044692615AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110606000476 GA Practitioner - Physician Assistant 2264619931 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1067 Peachtree St
Louisville, GA 30434-1558
Phone (478) 625-7000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
004764GAMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Hospital Authority of Jefferson County and the City of Louisville CurrentSince Apr 2, 2011 Accepting new patients
Hospital Authority of Jefferson County and the City of Louisville Past Accepting new patients
Hospital Authority of Jefferson County and the City of Louisville Past Accepting new patients
Hospital Authority of Jefferson County and the City of Louisville Past Accepting new patients
Hospital Authority of Jefferson County and the City of Louisville Past Accepting new patients

Locations

1067 Peachtree St
Louisville, GA 30434
Phone (478) 625-7000

1067 Peachtree St
#104
Louisville, GA 30434
Phone (912) 625-7000

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538092800000",
    "number": "1710087101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1067 PEACHTREE ST",
            "city": "LOUISVILLE",
            "state": "GA",
            "postal_code": "304341558",
            "telephone_number": "478-625-7000",
            "fax_number": "478-625-8907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1067 PEACHTREE ST",
            "city": "LOUISVILLE",
            "state": "GA",
            "postal_code": "304341558",
            "telephone_number": "478-625-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANNER",
        "first_name": "JENNIFER",
        "middle_name": "HADDEN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-25",
        "last_updated": "2018-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "004764",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "044692615A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, GA

Sources for this page

Verify at the official NPI Registry.