Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MD24621 | TN |
NPI | 1275576332 |
---|---|
Provider Name | Dr. Catherine Coburn Tanner |
First Address | Mtn Home, TN 37684 |
Second Address | Mtn Home, TN 37684 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 08/07/2007 |