NPI age
17 years
Enumerated 2008-08-07
● Active
Type 1 · Individual
MRS. Tabetha Broome Renner, PA-AC
Renner is 1 of 49 anesthesiologist assistant providers in MacOn and 1 of 1530 in Georgia.
Primary specialty
Anesthesiologist Assistant
Plus 1 subspecialty
Licensed in
GA
1 state
Status
Active
No deactivations on record
Last NPPES update
2022-04-13
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org
How this provider compares
Across 1530 active anesthesiologist assistant providers in Georgia.
NPI age
17 years
↑ 5 yr above median (12 yr)
State licenses
1 state
5% of peers hold multiple states
Subspecialties
0
22% of peers hold subspecialties
NPI lifetime · 2008 → 2026
2008-08Enumerated in NPPES
2008
2026
Where they practice
Practice location
400 Charter Blvd
MacOn, GA 312104831
Mailing address
Po Box 2564
MacOn, GA 312032565
Additional practice locations
1 secondary location on file with NPPES.
Location 2
380 Hospital Dr, Suite 410
MacOn, GA 31217
Specialties
-
Anesthesiologist Assistant PrimaryAn individual certified by the state to perform anesthesia services under the direct supervision of an anesthesiologist. Anesthesiologist Assistants are required to have a bachelor's degree with a premed curriculum prior to entering a...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 606097755D | |
| 05 (GA) | 606097755G | |
| 01 (GA) | 580628385 | TRICARE |
| 01 (GA) | P01101055 | RAILROAD MEDICARE |
| 05 (GA) | 606097755E | |
| 05 (GA) | 606097755F | |
| 01 (GA) | 578310 | WELLCARE |
Practice context
Part of a multi-provider practice. 24 other active providers share this practice address in NPPES.
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