Basic Information
| Provider Information | |||||||||
| NPI: | 1548471337 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TATTNALL COMMUNITY HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TATTNALL COMMUNITY HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 247 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | REIDSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304534605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125571000 | ||||||||
| FaxNumber: | 9125571009 | ||||||||
| Practice Location | |||||||||
| Address1: | 247 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | REIDSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304534605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9125571000 | ||||||||
| FaxNumber: | 9125571009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 01/08/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LEWIS | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9125571000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 132-601 | GA | Y | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.