Provider Demographics
NPI:1760648521
Name:TMC TANNER PAIN MANAGEMENT CENTER, INC.
Entity Type:Organization
Organization Name:TMC TANNER PAIN MANAGEMENT CENTER, INC.
Other - Org Name:TANNER PAIN MANAGEMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-838-8302
Mailing Address - Street 1:119 AMBULANCE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3857
Mailing Address - Country:US
Mailing Address - Phone:770-838-8710
Mailing Address - Fax:770-838-8563
Practice Address - Street 1:150 HENRY BURSON DR.
Practice Address - Street 2:SUITE 110
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4465
Practice Address - Country:US
Practice Address - Phone:770-812-5720
Practice Address - Fax:770-836-9663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty