Basic Information
| Provider Information | |||||||||
| NPI: | 1366906521 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TANNER MEDICAL CENTER ALABAMA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 PROFESSIONAL PL STE 305 | ||||||||
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| City: | CARROLLTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301173872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708128614 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1032 MAIN ST S | ||||||||
| Address2: | |||||||||
| City: | WEDOWEE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 362787440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563572111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2019 | ||||||||
| LastUpdateDate: | 01/22/2019 | ||||||||
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| AuthorizedOfficialLastName: | CREWS | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7708129745 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.