| Tanner Medical Clinic Llc | |
|
20104 Swanner Blvd Suite 4 Tanner AL 35671-3651 | |
| (256) 686-3334 | |
| (256) 686-3339 |
| Full Name | Tanner Medical Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 20104 Swanner Blvd, Tanner, Alabama |
| Authorized Official Name and Position | Michelle Sloan Graham (VP OF OPERATIONS) |
| Authorized Official Contact | 2564322822 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tanner Medical Clinic Llc 20104 Swanner Blvd Tanner AL 35671-3651 Ph: (256) 686-3334 | Tanner Medical Clinic Llc 20104 Swanner Blvd Suite 4 Tanner AL 35671-3651 Ph: (256) 686-3334 |
| NPI Number | 1376881870 |
|---|---|
| Provider Enumeration Date | 01/18/2013 |
| Last Update Date | 05/23/2023 |
| Medicare PECOS PAC ID | 8921245796 |
|---|---|
| Medicare Enrollment ID | O20130515000221 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376881870 | NPI | - | NPPES |
| 159174 | Medicaid | AL |
| Provider Name | Gregory S Cheatham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003844754 PECOS PAC ID: 4486620697 Enrollment ID: I20040909000149 |
| Provider Name | Johnna Hines Langford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427311331 PECOS PAC ID: 9638498546 Enrollment ID: I20150427001723 |
| Provider Name | Kimberley Brooke Tanner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023537073 PECOS PAC ID: 1658612049 Enrollment ID: I20190412000024 |
| Provider Name | Michelle Sloan Graham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255894994 PECOS PAC ID: 5395088041 Enrollment ID: I20190520002873 |
| Provider Name | Halli Flannagin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215598511 PECOS PAC ID: 4688902323 Enrollment ID: I20190820001316 |
Tanner Community Care Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 11185 Hwy 31, Tanner, AL 35671 Phone: 256-216-9658 Fax: 256-216-9659 |