Healthcare Provider Details

I. General information

NPI: 1043160575
Provider Name (Legal Business Name): TMC/VILLA RICA HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 GLEN EAGLE CT STE A
CARROLLTON GA
30117-4453
US

IV. Provider business mailing address

300 GLEN EAGLE CT STE A
CARROLLTON GA
30117-4453
US

V. Phone/Fax

Practice location:
  • Phone: 770-812-5085
  • Fax: 770-812-5086
Mailing address:
  • Phone: 770-812-5085
  • Fax: 770-812-5086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CAROL S. CREWS
Title or Position: CFO
Credential:
Phone: 770-812-9745