Provider Demographics
NPI:1720015084
Name:LIM, TANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:TANNA
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DAE
Other - Middle Name:
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:303 PARKWAY DR NE
Mailing Address - Street 2:DEPT OF GME
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:285 BOULEVARD NE
Practice Address - Street 2:SUITE 525
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-4205
Practice Address - Country:US
Practice Address - Phone:404-265-1044
Practice Address - Fax:404-265-1047
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055071207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA529641667EMedicaid
GAI33228Medicare UPIN
GA511I110079Medicare PIN