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General NPI Number Information
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NPI Number | 1609032077
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Entity Type | Organization
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Legal Business Name | TATTNALL NURSING, LLC
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Dates
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Enumeration Date | 08/05/2008
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Last Update Date | 08/05/2008
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Provider Practice Location Address
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Address Line | 142 MEMORIAL DR
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City | REIDSVILLE
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State | GA
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Zip | 30453-4652
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Country | US
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Telephone | 912-557-4345
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Fax | 912-557-3019
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Provider Business Mailing Address
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Address Line | 142 MEMORIAL DR
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City | REIDSVILLE
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State | GA
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Zip | 30453-4652
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Country | US
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Telephone | 912-557-4345
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Fax | 912-557-3019
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Authorized Official
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Title or Position | MANAGER
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Name | MR. TERRY TOLSON
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Credential |
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Telephone | 404-644-0471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 11321936
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License Number State | GA
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