Pro-Med of Atlanta, PC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

AT2218116 Issued in GA

Legal business name

PRO-MED OF ATLANTA, PC

Practice address

4646 North Shallowford Road
#400
Atlanta, GA 30338

Phone

(770) 676-6000

Fax

(770) 392-9805

NPI assigned

Jul 10, 2010

Last updated

Jul 10, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Susan Tanner, M.D.

Title

Medical Doctor

Phone

(770) 676-6000

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1278720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278720000000",
    "number": "1730491473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4646 N SHALLOWFORD RD",
            "address_2": "#400",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303386308",
            "telephone_number": "770-676-6000",
            "fax_number": "770-392-9805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4646 NORTH SHALLOWFORD ROAD",
            "address_2": "#400",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30338",
            "telephone_number": "770-676-6000",
            "fax_number": "770-392-9805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO-MED OF ATLANTA, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-10",
        "last_updated": "2010-07-10",
        "status": "A",
        "authorized_official_last_name": "TANNER",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "770-676-6000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "GA",
            "license": "AT2218116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• General Practice Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.