Provider Demographics
NPI:1104403740
Name:MABRY, TANNER (DO)
Entity type:Individual
Prefix:DR
First Name:TANNER
Middle Name:
Last Name:MABRY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1559 NC 27 E
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-7117
Mailing Address - Country:US
Mailing Address - Phone:321-442-2213
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL CENTER BLVD.
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-1087
Practice Address - Country:US
Practice Address - Phone:336-716-4551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program