Healthcare Provider Details

I. General information

NPI: 1104066265
Provider Name (Legal Business Name): TMC/VILLA RICA HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 DALLAS HWY
VILLA RICA GA
30180-1202
US

IV. Provider business mailing address

PO BOX 638
VILLA RICA GA
30180-0638
US

V. Phone/Fax

Practice location:
  • Phone: 770-456-3000
  • Fax: 770-456-3390
Mailing address:
  • Phone: 770-836-9666
  • Fax: 770-456-3390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MR. LEE C. SHERSETH
Title or Position: CFO
Credential:
Phone: 770-836-9697