Provider Demographics
NPI:1063578862
Name:TAYLOR TELFAIR REGIONAL HOSPITAL, INC
Entity type:Organization
Organization Name:TAYLOR TELFAIR REGIONAL HOSPITAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:PO 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:2006-12-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA134-554275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11Z301Medicare Oscar/Certification