Provider Demographics
NPI:1932454097
Name:TANON, VILMARIE J (MD)
Entity Type:Individual
Prefix:
First Name:VILMARIE
Middle Name:J
Last Name:TANON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 PRESIDENT PL STE 110
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6845
Mailing Address - Country:US
Mailing Address - Phone:615-625-7780
Mailing Address - Fax:615-625-7781
Practice Address - Street 1:739 PRESIDENT PL STE 110
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6845
Practice Address - Country:US
Practice Address - Phone:615-628-7780
Practice Address - Fax:615-625-7781
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR020746208000000X
TN50494208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN50494OtherSTATE LICENSE
PR020746OtherMEDICAL LICENSE