Provider Demographics
NPI:1154563666
Name:TANNER PRIMARY CARE OF HEFLIN
Entity type:Organization
Organization Name:TANNER PRIMARY CARE OF HEFLIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR V.P.
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:
Authorized Official - Last Name:DREILING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-812-5304
Mailing Address - Street 1:119 AMBULANCE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3857
Mailing Address - Country:US
Mailing Address - Phone:770-812-6570
Mailing Address - Fax:
Practice Address - Street 1:150 TOMPKINS ST
Practice Address - Street 2:
Practice Address - City:HEFLIN
Practice Address - State:AL
Practice Address - Zip Code:36264-1836
Practice Address - Country:US
Practice Address - Phone:770-812-6570
Practice Address - Fax:770-812-6575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty