| Tanner Neuroscience Specialist | |
|
705 Dixie St Carrollton GA 30117-3818 | |
| (770) 812-9697 | |
| Not Available |
| Full Name | Tanner Neuroscience Specialist |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 705 Dixie St, Carrollton, Georgia |
| Authorized Official Name and Position | Carol Crews (CFO) |
| Authorized Official Contact | 7708129580 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tanner Neuroscience Specialist 100 Greenway Blvd Fl 2 Carrollton GA 30117-4338 Ph: (770) 838-8710 | Tanner Neuroscience Specialist 705 Dixie St Carrollton GA 30117-3818 Ph: (770) 812-9697 |
| NPI Number | 1588192660 |
|---|---|
| Provider Enumeration Date | 06/01/2017 |
| Last Update Date | 02/29/2024 |
| Certification Date | 02/29/2024 |
| Medicare PECOS PAC ID | 3375801434 |
|---|---|
| Medicare Enrollment ID | O20171218003522 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588192660 | NPI | - | NPPES |
| PENDING | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Bonnie K Boles |
|---|---|
| Provider Type | Practitioner - Critical Care (intensivists) |
| Provider Identifiers | NPI Number: 1538161492 PECOS PAC ID: 9234184300 Enrollment ID: I20050322000476 |
| Provider Name | Christopher S Russell |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1609866839 PECOS PAC ID: 4385685239 Enrollment ID: I20050520000290 |
| Provider Name | Andrei I Serbanescu |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1528032703 PECOS PAC ID: 5698854552 Enrollment ID: I20080502000377 |
| Provider Name | Mitzi Joi Williams |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1356461248 PECOS PAC ID: 3476624669 Enrollment ID: I20080616000398 |
| Provider Name | Douglas Stuart |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1548251572 PECOS PAC ID: 5890738595 Enrollment ID: I20081118000053 |
| Provider Name | Jeffrey English |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1508856790 PECOS PAC ID: 3375681463 Enrollment ID: I20091110000539 |
| Provider Name | Heidi T Woessner |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1225272941 PECOS PAC ID: 0749428928 Enrollment ID: I20130824000241 |
| Provider Name | Joash T Lazarus |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1720374754 PECOS PAC ID: 1254652829 Enrollment ID: I20150608001888 |
| Provider Name | Anna Katema |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1891051231 PECOS PAC ID: 7315205259 Enrollment ID: I20171221002377 |
| Provider Name | Jeffrey Stevens |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1164868212 PECOS PAC ID: 6608157664 Enrollment ID: I20190612001759 |
| Provider Name | Chad Cox |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1518385384 PECOS PAC ID: 5597096776 Enrollment ID: I20200618003113 |
| Provider Name | Yulia Salamatova |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1285138495 PECOS PAC ID: 3779835533 Enrollment ID: I20220929000456 |
| Provider Name | Meena R. Kannan |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1841589249 PECOS PAC ID: 0749591824 Enrollment ID: I20230331000166 |
| Provider Name | Bosten Miller |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1932554896 PECOS PAC ID: 8022304666 Enrollment ID: I20230928002284 |
| Provider Name | Jonathan Lewis |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1205246741 PECOS PAC ID: 2668690256 Enrollment ID: I20231211002555 |
| Provider Name | Nicholas Lambert |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1902225295 PECOS PAC ID: 0648692806 Enrollment ID: I20240129003468 |
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