Provider Demographics
NPI:1679195606
Name:TMC VILLA RICA HOSPITAL, INC
Entity Type:Organization
Organization Name:TMC VILLA RICA HOSPITAL, INC
Other - Org Name:NW GA ONCOLOGY CTR RETAIL PHARMACY - TMC/VILLA RICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:S
Authorized Official - Last Name:CREWS
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:770-812-9745
Mailing Address - Street 1:100 PROFESSIONAL PL STE 305
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3872
Mailing Address - Country:US
Mailing Address - Phone:770-812-8614
Mailing Address - Fax:770-812-8372
Practice Address - Street 1:157 CLINIC AVE STE 202, ROOM 219
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4454
Practice Address - Country:US
Practice Address - Phone:770-812-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TMC VILLA RICA HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-13
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5KYKWKNF2OtherHEALTH INDUSTRY NUMBER