Healthcare Provider Details

I. General information

NPI: 1457183311
Provider Name (Legal Business Name): TATTNALL HOSPITAL COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 CHARLES ANDREW DR UNIT 112
VIDALIA GA
30474-7241
US

IV. Provider business mailing address

440 MALL BLVD STE C
SAVANNAH GA
31406-4868
US

V. Phone/Fax

Practice location:
  • Phone: 912-557-1330
  • Fax: 833-973-0972
Mailing address:
  • Phone: 912-644-3340
  • Fax: 912-644-5398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID ALEX VILLA
Title or Position: CEO
Credential:
Phone: 706-468-7765