NPIMap

Organization Active NPI

Tattnall Hospital Company, LLC

  • Pain Medicine Physician
  • Hinesville, GA
National Provider Identifier
1326409442
Registry record updated Jan 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
Legal business name
TATTNALL HOSPITAL COMPANY, LLC
Practice address
790 Veterans Pkwy
Suite 111
Hinesville, GA 31313-3915
Phone
(912) 877-4400
Fax
(912) 877-4404
NPI assigned
Mar 17, 2016
Organization subpart
Yes
Parent organization
TATTNALL HOSPITAL COMPANY, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 8, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David Alex Villa
Title
Ceo
Phone
(912) 629-7797

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207T00000X
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X
Pain Medicine (Psychiatry & Neurology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P2900X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X Primary

Addresses

Primary practice location

790 Veterans Pkwy
Suite 111
Hinesville, GA 31313-3915

Mailing address

440 Mall Blvd Ste C
Savannah, GA 31406-4868
Phone (912) 644-3340

Other names 1

  • Optim Medical Center - Tattnall Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080915000167 GA Part B Supplier - Clinic/Group Practice 6204907124 Receives reassigned benefits from 63 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Reidsville, GA; Swainsboro, GA; Richmond Hill, GA; Rincon, GA; Sandersville, GA; Savannah, GA; Statesboro, GA; Sylvania, GA…

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2063639Tattnall Hospital Company, LLC790 Veterans Pkwy, Suite 111, Hinesville, GA 31313Certificate of waiverAug 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
Coastal Imaging21 organizations share this tax ID, including this one
Part of
Coastal Imaging

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

Locations

16915 Highway 67
#A
Statesboro, GA 30458
Phone (912) 681-2500

Practitioners & affiliated clinicians

Practitioners 57

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 57

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1458172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767830400000",
    "number": "1326409442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 MALL BLVD STE C",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314064868",
            "telephone_number": "912-644-3340",
            "fax_number": "912-644-5398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 VETERANS PKWY",
            "address_2": "SUITE 111",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313133915",
            "telephone_number": "912-877-4400",
            "fax_number": "912-877-4404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TATTNALL HOSPITAL COMPANY, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TATTNALL HOSPITAL COMPANY, LLC",
        "enumeration_date": "2016-03-17",
        "last_updated": "2026-01-08",
        "certification_date": "2026-01-08",
        "status": "A",
        "authorized_official_last_name": "VILLA",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ALEX",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "912-629-7797"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optim Medical Center - Tattnall",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Optim Medical Center - Tattnall",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hinesville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.