Basic Information
| Provider Information | |||||||||
| NPI: | 1912428301 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TANNER MEDICAL CENTER ALABAMA INC | ||||||||
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| OtherOrganizationName: | TANNER MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 705 DIXIE ST | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301173818 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1032 MAIN ST SOUTH | ||||||||
| Address2: | |||||||||
| City: | WEDOWEE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 362785139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563572111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2017 | ||||||||
| LastUpdateDate: | 10/03/2019 | ||||||||
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| AuthorizedOfficialLastName: | CREWS | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7708129745 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | Y | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.