Provider Demographics
NPI:1477858116
Name:TANNER, RICHARD (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:TANNER
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 1:144 MEDICAL CENTER DR STE C
Mailing Address - Street 2:PO BOX 1173
Mailing Address - City:COPPERHILL
Mailing Address - State:TN
Mailing Address - Zip Code:37317-5006
Mailing Address - Country:US
Mailing Address - Phone:423-548-1520
Mailing Address - Fax:423-548-1521
Practice Address - Street 1:144 MEDICAL CENTER DR STE C
Practice Address - Street 2:
Practice Address - City:COPPERHILL
Practice Address - State:TN
Practice Address - Zip Code:37317-5006
Practice Address - Country:US
Practice Address - Phone:423-548-1520
Practice Address - Fax:423-548-1521
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO2391207R00000X
GA074384207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine