| Tanner Medical Center Villa Rica Bh | |
|
101 Quartz Dr Ste 103a Villa Rica GA 30180-3256 | |
| (770) 456-3266 | |
| Not Available |
| Full Name | Tanner Medical Center Villa Rica Bh |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 101 Quartz Dr Ste 103a, Villa Rica, Georgia |
| Authorized Official Name and Position | Carol Crews (CFO) |
| Authorized Official Contact | 7708369745 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tanner Medical Center Villa Rica Bh 705 Dixie St Carrollton GA 30117-3818 Ph: (770) 836-9666 | Tanner Medical Center Villa Rica Bh 101 Quartz Dr Ste 103a Villa Rica GA 30180-3256 Ph: (770) 456-3266 |
| NPI Number | 1033441290 |
|---|---|
| Provider Enumeration Date | 02/12/2010 |
| Last Update Date | 05/10/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033441290 | NPI | - | NPPES |
| 1871502260 | Other | GA | ORGANIZATIONAL NPI |
| 296667723B | Medicaid | GA | |
| 300027104A | Other | GA | MEDICAID PAYEE IDENTIFICATION NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | NOT REQUIRED (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | NOT REQUIRED (* (Not Available)) | Primary |
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