Provider Demographics
NPI:1427858547
Name:TANNER, RICHARD KEVIN
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:KEVIN
Last Name:TANNER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:NICHOLLS
Mailing Address - State:GA
Mailing Address - Zip Code:31554-5040
Mailing Address - Country:US
Mailing Address - Phone:912-493-0312
Mailing Address - Fax:912-493-0312
Practice Address - Street 1:202 S JOHNSON ST
Practice Address - Street 2:
Practice Address - City:NICHOLLS
Practice Address - State:GA
Practice Address - Zip Code:31554-5040
Practice Address - Country:US
Practice Address - Phone:912-493-0312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program