Healthcare Provider Details

I. General information

NPI: 1033445523
Provider Name (Legal Business Name): TATTNALL HOSPITAL COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 MEMORIAL DRIVE
REIDSVILLE GA
30453-4605
US

IV. Provider business mailing address

210 E. DERENNE AVENUE ATTN: CREDENTIALING DEPARTMENT
SAVANNAH GA
31406-0000
US

V. Phone/Fax

Practice location:
  • Phone: 912-557-6224
  • Fax: 912-644-5260
Mailing address:
  • Phone: 912-644-5300
  • Fax: 770-248-6753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID PERRY
Title or Position: CEO
Credential:
Phone: 912-644-5300