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General NPI Number Information
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NPI Number | 1619182102
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Entity Type | Organization
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Legal Business Name | TATTNALL HEALTHCARE LLC.
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 12/06/2007
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Provider Practice Location Address
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Address Line | 121 N CASWELL ST
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City | GLENNVILLE
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State | GA
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Zip | 30427-2017
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Country | US
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Telephone | 912-654-1080
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Fax |
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Provider Business Mailing Address
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Address Line | 121 N CASWELL ST
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City | GLENNVILLE
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State | GA
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Zip | 30427-2017
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Country | US
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Telephone | 912-654-1080
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Fax |
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Authorized Official
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Title or Position | C.F.O.
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Name | MR. JOSEPH A LEWIS
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Credential |
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Telephone | 912-557-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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