Provider Demographics
NPI:1952416901
Name:TATTNALL HEALTHCARE LLC
Entity Type:Organization
Organization Name:TATTNALL HEALTHCARE LLC
Other - Org Name:TATTNALL MEDICAL GROUP-COBBTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-557-1000
Mailing Address - Street 1:36671 HWY. 23
Mailing Address - Street 2:
Mailing Address - City:COBBTOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30420
Mailing Address - Country:US
Mailing Address - Phone:912-684-3692
Mailing Address - Fax:912-684-3695
Practice Address - Street 1:36671 HWY. 23
Practice Address - Street 2:
Practice Address - City:COBBTOWN
Practice Address - State:GA
Practice Address - Zip Code:30420
Practice Address - Country:US
Practice Address - Phone:912-684-3692
Practice Address - Fax:912-684-3695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA118512Medicare PIN