Provider Demographics
NPI:1891009924
Name:TATTNALL HOSPITAL COMPANY, LLC
Entity Type:Organization
Organization Name:TATTNALL HOSPITAL COMPANY, LLC
Other - Org Name:OPTIM MEDICAL CENTER- TATTNALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY OF COMM. HOSP. HOLD. CO.,
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GUENTHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-627-8427
Mailing Address - Street 1:210 E DERENNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-644-5300
Mailing Address - Fax:912-644-5260
Practice Address - Street 1:110 EAST TOLLISON STREET
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513
Practice Address - Country:US
Practice Address - Phone:800-827-6536
Practice Address - Fax:912-644-5260
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TATTNALL HOSPITAL COMPANY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-30
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207T00000X
GA207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty