Provider Demographics
NPI:1003939794
Name:NW GA REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:NW GA REGIONAL HOSPITAL
Other - Org Name:PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PATIENT ACCOUNTS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-295-6298
Mailing Address - Street 1:705 N DIVISION ST NW
Mailing Address - Street 2:PATIENT ACCOUNTS OFFICE
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1454
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:705 N DIVISION ST NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1454
Practice Address - Country:US
Practice Address - Phone:706-295-6298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF GEORGIA DEPARTMENT OF HUMAN RESOURCES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-09
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA114014OtherMEDICARE PROVIDER NUMBER
GA000355748AMedicaid