Healthcare Provider Details

I. General information

NPI: 1033428214
Provider Name (Legal Business Name): SCREVEN COUNTY HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

961 E WINTHROPE AVE
MILLEN GA
30442-1839
US

IV. Provider business mailing address

460 MALL BLVD STE B
SAVANNAH GA
31406-4891
US

V. Phone/Fax

Practice location:
  • Phone: 478-982-9081
  • Fax: 478-982-8843
Mailing address:
  • Phone: 912-644-1626
  • Fax: 912-644-3369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateGA

VIII. Authorized Official

Name: DAVID ALEX VILLA
Title or Position: CEO
Credential:
Phone: 505-695-9410