Healthcare Provider Details

I. General information

NPI: 1063766582
Provider Name (Legal Business Name): TANNER MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 DIXIE ST
CARROLLTON GA
30117-3818
US

IV. Provider business mailing address

705 DIXIE ST
CARROLLTON GA
30117-3818
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MR. LEE SHERSETH
Title or Position: CFO
Credential:
Phone: 770-836-9697