Provider Demographics
NPI:1437223914
Name:NW GA REGIONAL HOSPITAL ICF MR
Entity type:Organization
Organization Name:NW GA REGIONAL HOSPITAL ICF MR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNTS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-295-6298
Mailing Address - Street 1:1305 REDMOND CIR NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1345
Mailing Address - Country:US
Mailing Address - Phone:706-295-6298
Mailing Address - Fax:706-802-5400
Practice Address - Street 1:1305 REDMOND CIR NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1345
Practice Address - Country:US
Practice Address - Phone:706-295-6298
Practice Address - Fax:706-802-5400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF GEORGIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-17
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities