Provider Demographics
NPI:1538193438
Name:GARDNER, ERINN L (MD)
Entity type:Individual
Prefix:MRS
First Name:ERINN
Middle Name:L
Last Name:GARDNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:ERINN
Other - Middle Name:L
Other - Last Name:TUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8200 ROBERTS DR STE 450
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-4115
Mailing Address - Country:US
Mailing Address - Phone:770-952-8612
Mailing Address - Fax:678-803-6944
Practice Address - Street 1:100 OLD BALL GROUND HWY
Practice Address - Street 2:SUITE B
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2890
Practice Address - Country:US
Practice Address - Phone:770-953-3331
Practice Address - Fax:770-720-8211
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA59413207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA688142215BMedicaid
GA688142215DMedicaid
GA688142215EMedicaid
GA688142215CMedicaid
GA688142215FMedicaid