Provider Demographics
NPI:1891810479
Name:VENN, TAD ALAN (MD)
Entity Type:Individual
Prefix:
First Name:TAD
Middle Name:ALAN
Last Name:VENN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 402145
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-2145
Mailing Address - Country:US
Mailing Address - Phone:803-296-7305
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:100 PALMETTO HEALTH PKWY
Practice Address - Street 2:SUITE G-100
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-1753
Practice Address - Country:US
Practice Address - Phone:803-434-4700
Practice Address - Fax:803-434-8747
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27863207RG0300X, 207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA41005770Medicare PIN