Provider Demographics
NPI:1528181211
Name:NW GA REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:NW GA REGIONAL HOSPITAL
Other - Org Name:THE BENCHMARK - HOME B
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 1:1305 REDMOND CIR NW
Mailing Address - Street 2:PATIENT ACCOUNTS OFFICE
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1345
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23 WIDGEON WAY NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1361
Practice Address - Country:US
Practice Address - Phone:706-295-6298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health