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General NPI Number Information
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NPI Number | 1871502260
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Entity Type | Organization
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Legal Business Name | TANNER MEDICAL CENTER, INC
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Dates
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Enumeration Date | 08/05/2006
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 101 DOCTORS DR
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City | CARROLLTON
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State | GA
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Zip | 30117-4486
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Country | US
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Telephone | 770-836-9697
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Fax | 770-836-9897
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Provider Business Mailing Address
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Address Line | 109 CEDAR ST STE C
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City | CARROLLTON
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State | GA
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Zip | 30117-2667
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Country | US
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Telephone | 770-812-5770
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Fax | 770-836-9897
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Authorized Official
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Title or Position | CFO
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Name | CAROL S. CREWS
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Credential |
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Telephone | 770-812-9745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | NOT REQUIRED
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 022-426
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License Number State | GA
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