NPIMap

Organization Active NPI

Tanner Medical Center, Inc.

Doing business as Tanner Boutique

  • Durable Medical Equipment & Medical Supplies
  • Carrollton, GA
National Provider Identifier
1104850965
Registry record updated Jun 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
004396 Issued in GA
Legal business name
TANNER MEDICAL CENTER, INC.
Doing business as
Tanner Boutique
Practice address
706 Dixie St Ste 110
Carrollton, GA 30117-3858
Phone
(770) 812-8338
NPI assigned
Jul 10, 2006
Last updated
Jun 26, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
TANNER MEDICAL CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 26, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Carol S. Crews
Title
Cfo
Phone
(770) 812-9745

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 004396 GA Primary
Prosthetic/Orthotic Supplier 335E00000X 004396 GA

Addresses

Primary practice location

706 Dixie St Ste 110
Carrollton, GA 30117-3858

Mailing address

705 Dixie St
Carrollton, GA 30117-3818
Phone (770) 836-9697

Other identifiers 2

IdentifierTypeStateIssuer
000001867BMedicaidGA
000001867CMedicaidGA

Other names 1

  • Tanner Boutique Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930060631 GA DME Supplier - Medical Supply Company 2769387539 Practice locations: Carrollton, GA

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Tanner Medical Center Inc706 Dixie St, Carrollton, GA 30117-3858(770) 812-8338 Breast Prostheses and/or Accessories Accepts assignmentParticipating since Jun 1, 2009

National Provider Directory

National Provider Directory
Tax ID family
Tanner Medical Center Inc2 organizations share this tax ID, including this one
Part of
Tanner Medical Center Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 17

Organizations listed as members of this organization in the National Provider Directory.

View all 17

Locations

100 Professional Pl
Ste 305
Carrollton, GA 30117

Ownership & related parties

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Tanner Medical Center IncCarrollton, GA, CCN 110011 Hospital Operational/Managerial Control (100%) Feb 1, 2014
TMC Villa Rica Hospital, IncVilla Rica, GA, CCN 110015 Hospital 5% Or Greater Direct Ownership Interest Jan 23, 2025
TMC/Higgins General HospitalBremen, GA, CCN 11Z320 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 8, 2025
TMC/Higgins General HospitalBremen, GA, CCN 111320 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 8, 2025
Tanner Home Health ServicesCarrollton, GA, CCN 117319 Home health agency 5% Or Greater Direct Ownership Interest (100%) Feb 20, 2009
Buchanan Medical ClinicBuchanan, GA, CCN 118549 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Aug 1, 2013

Owned or controlled facilities with NPI records 6

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750896000000",
    "number": "1104850965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 DIXIE ST",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173818",
            "telephone_number": "770-836-9697",
            "fax_number": "770-836-9897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 DIXIE ST STE 110",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173858",
            "telephone_number": "770-812-8338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TANNER MEDICAL CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TANNER MEDICAL CENTER, INC.",
        "enumeration_date": "2006-07-10",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A",
        "authorized_official_last_name": "CREWS",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "770-812-9745"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "GA",
            "license": "004396",
            "primary": true
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "GA",
            "license": "004396",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000001867B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000001867C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tanner Boutique",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carrollton, GA

Sources for this page

Verify at the official NPI Registry.