Basic Information
| Provider Information | |||||||||
| NPI: | 1154820876 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TANNER IMAGING CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 PROFESSIONAL PARK STE. 305 | ||||||||
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| City: | CARROLLTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708128614 | ||||||||
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| Practice Location | |||||||||
| Address1: | 119 AMBULANCE DR | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301173857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708129660 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2018 | ||||||||
| LastUpdateDate: | 02/08/2018 | ||||||||
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| AuthorizedOfficialLastName: | CREWS | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7708129580 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology |
No ID Information.