MEDICARE: NW GA REGIONAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336I0012X	Institutional Pharmacy

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	114014	OTHER	GA	MEDICARE PROVIDER NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003939794
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NW GA REGIONAL HOSPITAL

Provider Business Mailing Address
First Line	:	705 N DIVISION ST NW
Second Line	:	PATIENT ACCOUNTS OFFICE
City	:	ROME
State	:	GA
Zip	:	30165-1454
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 N DIVISION ST NW
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30165-1454
Country	:	US
Telephone Number	:	706-295-6298
Fax Number	:

Authorized Official
Title or Position	:	PATIENT ACCOUNTS OFFICER
Name	:	TAMMY VAUGHN
Credential	:
Telephone Number	:	706-295-6298

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	06/23/2009

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Directions to “NW GA REGIONAL HOSPITAL ” Practice Location

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