Provider Demographics
NPI:1477909364
Name:TATTNALL HOSPITAL COMPANY LLC
Entity Type:Organization
Organization Name:TATTNALL HOSPITAL COMPANY LLC
Other - Org Name:OPTIM THERAPY - VIDALIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER ENROLLMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-644-5346
Mailing Address - Street 1:460 MALL BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-4801
Mailing Address - Country:US
Mailing Address - Phone:912-644-1626
Mailing Address - Fax:912-644-5260
Practice Address - Street 1:3301 E 1ST ST
Practice Address - Street 2:SUITE B
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8674
Practice Address - Country:US
Practice Address - Phone:912-537-0888
Practice Address - Fax:912-537-8820
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TATTNALL HOSPITAL COMPANY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-10
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty