Provider Demographics
NPI:1366906521
Name:TANNER MEDICAL CENTER ALABAMA INC
Entity type:Organization
Organization Name:TANNER MEDICAL CENTER ALABAMA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:S
Authorized Official - Last Name:CREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-812-9745
Mailing Address - Street 1:100 PROFESSIONAL PL STE 305
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3872
Mailing Address - Country:US
Mailing Address - Phone:770-812-8614
Mailing Address - Fax:
Practice Address - Street 1:1032 MAIN ST S
Practice Address - Street 2:
Practice Address - City:WEDOWEE
Practice Address - State:AL
Practice Address - Zip Code:36278-7440
Practice Address - Country:US
Practice Address - Phone:256-357-2111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty