Basic Information
| Provider Information | |||||||||
| NPI: | 1336290667 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHATHAM HOSPTIALISTS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5354 REYNOLDS ST | ||||||||
| Address2: | STE 424 | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314056007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9128195999 | ||||||||
| FaxNumber: | 9128195980 | ||||||||
| Practice Location | |||||||||
| Address1: | 5354 REYNOLDS ST | ||||||||
| Address2: | STE 424 | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314056007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9128195999 | ||||||||
| FaxNumber: | 9128195980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2007 | ||||||||
| LastUpdateDate: | 04/30/2014 | ||||||||
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| AuthorizedOfficialLastName: | STRICKLAND | ||||||||
| AuthorizedOfficialFirstName: | HEATHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9128195999 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 944730936A | 05 | GA | MEDICAID | GPA974 | 05 | SC | MEDICAID |