Healthcare Provider Details

I. General information

NPI: 1104850965
Provider Name (Legal Business Name): TANNER MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 DIXIE ST STE 110
CARROLLTON GA
30117-3858
US

IV. Provider business mailing address

705 DIXIE ST
CARROLLTON GA
30117-3818
US

V. Phone/Fax

Practice location:
  • Phone: 770-812-8338
  • Fax:
Mailing address:
  • Phone: 770-836-9697
  • Fax: 770-836-9897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number004396
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number004396
License Number StateGA

VIII. Authorized Official

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