MEDICARE: TMC/VILLA RICA HOSPITAL, INC

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	3336S0011X	Specialty Pharmacy
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1043160575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TMC/VILLA RICA HOSPITAL, INC

Provider Business Mailing Address
First Line	:	300 GLEN EAGLE CT STE A
Second Line	:
City	:	CARROLLTON
State	:	GA
Zip	:	30117-4453
Country	:	US
Telephone Number	:	770-812-5085
Fax Number	:	770-812-5086

Provider Business Practice Location Address
First Line	:	300 GLEN EAGLE CT STE A
Second Line	:
City	:	CARROLLTON
State	:	GA
Zip	:	30117-4453
Country	:	US
Telephone Number	:	770-812-5085
Fax Number	:	770-812-5086

Authorized Official
Title or Position	:	CFO
Name	:	CAROL S. CREWS
Credential	:
Telephone Number	:	770-812-9745

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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