Organization
TANNER MEDICAL CENTER, INC.
Active
Parent organization
TANNER MEDICAL CENTER, INC.
Other names
Tanner Boutique
Organization subpart
Yes
Provider details
NPI number
Legal business name
TANNER MEDICAL CENTER, INC.
Authorized official
CAROL S. CREWS (CFO)
(770) 812-9745
Entity
Organization
Contact information
Practice address
706 DIXIE ST STE 110, CARROLLTON, GA 30117-3858
(770) 812-8338
Mailing address
705 DIXIE ST, CARROLLTON, GA 30117-3818
(770) 836-9697
(770) 836-9897
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
004396
GA
335E00000X
Prosthetic/Orthotic Supplier
004396
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000001867B
—
GA
05
—
000001867C
—
GA
Enumeration date
07/10/2006
Last updated
06/26/2025
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