| Organization Name: | PRO-MED OF ATLANTA, PC |
| NPI Number: | 1730491473 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SUSAN TANNER (MEDICAL DOCTOR) |
| Mailing Address: | 4646 North Shallowford Road #400 Atlanta |
| State: | GA US |
| Postal Code: | 30338 |
| Phone Number: | 7706766000 |
| Fax Number: | 7703929805 |
| NPI Enumeration Date: | 07/10/2010 |
| NPI Last Update Date: | 07/10/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |