Healthcare Provider Details

I. General information

NPI: 1871502260
Provider Name (Legal Business Name): TANNER MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DOCTORS DR
CARROLLTON GA
30117-4486
US

IV. Provider business mailing address

109 CEDAR ST STE C
CARROLLTON GA
30117-2667
US

V. Phone/Fax

Practice location:
  • Phone: 770-836-9697
  • Fax: 770-836-9897
Mailing address:
  • Phone: 770-812-5770
  • Fax: 770-836-9897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberNOT REQUIRED
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number022-426
License Number StateGA

VIII. Authorized Official

Name: CAROL S. CREWS
Title or Position: CFO
Credential:
Phone: 770-812-9745