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
1	208600000X	Surgery Physician
2	208VP0000X	Pain Medicine Physician
3	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician
4	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician
5	208100000X	Physical Medicine & Rehabilitation Physician
6	207T00000X	Neurological Surgery Physician
7	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1588103592
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	:	821 S MAIN ST STE C
Second Line	:
City	:	BAXLEY
State	:	GA
Zip	:	31513-0163
Country	:	US
Telephone Number	:	912-705-8040
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DAVID ALEX VILLA
Credential	:
Telephone Number	:	912-644-5300

Provider Enumeration Date	:	02/23/2017
Last Update Date	:	01/14/2026

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