MEDICARE: TATTNALL HOSPITAL COMPANY, LLC

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	208VP0000X	Pain Medicine Physician
2	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1457183311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TATTNALL HOSPITAL COMPANY, LLC

Provider Business Mailing Address
First Line	:	440 MALL BLVD STE C
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31406-4868
Country	:	US
Telephone Number	:	912-644-3340
Fax Number	:	912-644-5398

Provider Business Practice Location Address
First Line	:	104 CHARLES ANDREW DR UNIT 112
Second Line	:
City	:	VIDALIA
State	:	GA
Zip	:	30474-7241
Country	:	US
Telephone Number	:	912-557-1330
Fax Number	:	833-973-0972

Authorized Official
Title or Position	:	CEO
Name	:	DAVID ALEX VILLA
Credential	:
Telephone Number	:	706-468-7765

Provider Enumeration Date	:	08/19/2024
Last Update Date	:	01/14/2026

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Directions to “TATTNALL HOSPITAL COMPANY, LLC ” Practice Location

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