NPIMap

Organization Active NPI

Tanner Medical Center, Inc

  • Community/Behavioral Health Agency
  • Carrollton, GA
National Provider Identifier
1871502260
Registry record updated Oct 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
022-426 Issued in GA
Legal business name
TANNER MEDICAL CENTER, INC
Practice address
101 Doctors Dr
Carrollton, GA 30117-4486
Phone
(770) 836-9697
Fax
(770) 836-9897
NPI assigned
Aug 5, 2006
Last updated
Oct 2, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
TANNER MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 2, 2024

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
Counselor 101Y00000X NOT REQUIRED GA
Community/Behavioral Health Agency 251S00000X 022-426 GA Primary

Addresses

Primary practice location

101 Doctors Dr
Carrollton, GA 30117-4486

Mailing address

109 Cedar St Ste C
Carrollton, GA 30117-2667
Phone (770) 812-5770

Other identifiers 2

IdentifierTypeStateIssuer
296667723AMedicaidGA
300027104AOtherGAMEDICAID PAYEE IDENTIFICATION NUMBER

Other names 1

  • Tanner Medical Center Carrollton BH Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031204000654 GA Part B Supplier - Clinic/Group Practice 2769387539 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Villa Rica, GA
O20150929001447 GA Part B Supplier - Other Medical Care Group 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).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Tanner Medical Center Inc

Locations

101 Doctors Dr
Carrollton, GA 30117
Phone (770) 812-8863

101 Doctors Dr
Ste Ab
Carrollton, GA 30117
Phone (770) 836-9866

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": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727827200000",
    "number": "1871502260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 CEDAR ST STE C",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301172667",
            "telephone_number": "770-812-5770",
            "fax_number": "770-836-9897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 DOCTORS DR",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174486",
            "telephone_number": "770-836-9697",
            "fax_number": "770-836-9897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TANNER MEDICAL CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TANNER MEDICAL CENTER",
        "enumeration_date": "2006-08-05",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "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": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "GA",
            "license": "NOT REQUIRED",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "GA",
            "license": "022-426",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "296667723A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID PAYEE IDENTIFICATION NUMBER",
            "identifier": "300027104A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tanner Medical Center Carrollton BH",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Carrollton, GA

Sources for this page

Verify at the official NPI Registry.