Provider Demographics
NPI:1902388002
Name:GRANT, TANNER WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:WAYNE
Last Name:GRANT
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 1:2702 CUNNINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-6864
Mailing Address - Country:US
Mailing Address - Phone:334-403-0222
Mailing Address - Fax:
Practice Address - Street 1:7449 EASTCHASE PKWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-6846
Practice Address - Country:US
Practice Address - Phone:334-747-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL39104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine