Provider Demographics
NPI:1851398481
Name:TAYLOR TELFAIR REGIONAL HOSPITAL, INC
Entity Type:Organization
Organization Name:TAYLOR TELFAIR REGIONAL HOSPITAL, INC
Other - Org Name:TELFAIR REGIONAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-868-4145
Mailing Address - Street 1:ROUTE 1-HIGHWAY 341 SOUTH
Mailing Address - Street 2:P.O. BOX 150
Mailing Address - City:MCRAE
Mailing Address - State:GA
Mailing Address - Zip Code:31055-0150
Mailing Address - Country:US
Mailing Address - Phone:229-868-5621
Mailing Address - Fax:229-868-4131
Practice Address - Street 1:ROUTE 1 HIGHWAY 341 SOUTH
Practice Address - Street 2:
Practice Address - City:MCRAE
Practice Address - State:GA
Practice Address - Zip Code:31055-0150
Practice Address - Country:US
Practice Address - Phone:229-868-5621
Practice Address - Fax:229-868-4131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA134-554282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1275592255OtherHABIGALE CRIBE, MD
GA1598846818OtherEDMUND M WRIGHT, MD
GA00001889AMedicaid
GA1134199045OtherOSCAR SALVAT, MD
GA1275592255OtherHABIGALE CRIBE, MD
GAHOSP209Medicare ID - Type UnspecifiedPART B
GA111301Medicare Oscar/Certification