Healthcare Provider Details

I. General information

NPI: 1609032077
Provider Name (Legal Business Name): TATTNALL NURSING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2008
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 MEMORIAL DR
REIDSVILLE GA
30453-4652
US

IV. Provider business mailing address

142 MEMORIAL DR
REIDSVILLE GA
30453-4652
US

V. Phone/Fax

Practice location:
  • Phone: 912-557-4345
  • Fax: 912-557-3019
Mailing address:
  • Phone: 912-557-4345
  • Fax: 912-557-3019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number11321936
License Number StateGA

VIII. Authorized Official

Name: MR. TERRY TOLSON
Title or Position: MANAGER
Credential:
Phone: 404-644-0471