Tanner Boutique is a Prosthetic & Orthotic Supplier (Prosthetic & Orthotic Supplier) in Carrollton, Georgia. This organization is also known as sub part of Tanner Medical Center, Inc.. It is situated at 157 Clinic Ave, Suite 202, Carrollton and its contact number is 770-836-9697. The authorized person of Tanner Boutique is Mr. Lee C. Sherseth
who is Cfo of the store and his/her contact number is 770-836-9697. Primary license number for Tanner Boutique is 004396 in Georgia. Tanner Boutique is an organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition.
Complete Center Profile:
Tanner Boutique Center speciality, address, contact phone number and fax are as below.
Patients can directly walkin to the Prosthetic/Orthotic center or can call on the below given phone number for appointment.
157 Clinic Ave, Suite 202, Carrollton, Georgia, 30117-4454
Phone:
770-836-9697
Fax:
770-836-9897
Authorized/Official Person Profile:
Officially authorized person to contact for any management issues or complaints of this store are as below. Person's position and contact details are also mentioned below.
Name:
Mr. Lee C. Sherseth
Position:
Cfo
Contact Number:
770-836-9697
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details for Tanner Boutique center are as mentioned below.
NPI Number:
1104850965
Parent Organization:
Tanner Medical Center, Inc.
NPI Enumeration Date:
10 Jul, 2006
NPI Last Update On:
17 Mar, 2009
Medical Licenses:
Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Tanner Boutique are as mentioned below.
Specialization
License Number
State
Status
004396
Georgia
Primary
004396
Georgia
Secondary
Other Medical Identifiers:
Other legacy medical identifiers of the supplier such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
Identifier
Type
State
Issuer
000001867B
Medicaid
Georgia
000001867C
Medicaid
Georgia
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
Address:
Tanner Boutique 705 Dixie St, Carrollton, Georgia
Zip:
30117-3818
Phone Number:
770-836-9697
Fax Number:
770-836-9897
Patients can reach Tanner Boutique at 157 Clinic Ave, Suite 202, Carrollton, Georgia or can call to book an appointment on 770-836-9697. Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 11 March, 2024.
Comments/ Reviews:
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