Provider Demographics
NPI:1043229420
Name:TANNER OCCUPATIONAL HEALTH
Entity Type:Organization
Organization Name:TANNER OCCUPATIONAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHERSETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-836-9697
Mailing Address - Street 1:706 DIXIE ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3819
Mailing Address - Country:US
Mailing Address - Phone:770-836-9697
Mailing Address - Fax:770-836-9897
Practice Address - Street 1:706 DIXIE ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3819
Practice Address - Country:US
Practice Address - Phone:770-836-9697
Practice Address - Fax:770-836-9897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine