Organization
TANNER NEUROSCIENCE SPECIALIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL CREWS (CFO)
(770) 812-9580
Entity
Organization
Contact information
Practice address
705 DIXIE ST, CARROLLTON, GA 30117-3818
(770) 812-9697
Mailing address
100 GREENWAY BLVD FL 2, CARROLLTON, GA 30117-4338
(770) 838-8710
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
GA
Enumeration date
06/01/2017
Last updated
02/29/2024
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