Wwltach LLC

Primary specialty

Long Term Care HospitalTaxonomy code 282E00000X

Legal business name

WWLTACH LLC

Doing business as

Select Specialty Hospital - Northeast Atlanta

Practice address

1821 Clifton Rd NE
NE
Atlanta, GA 30329-4021

Phone

(404) 728-6200

NPI assigned

Apr 29, 2014

Organization subpart

No

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

Authorized official

Name

Michael Tarvin

Title

Vice President

Phone

(717) 972-1100

Specialties & licenses 1

Addresses

Other names 1

• Select Specialty Hospital - Northeast Atlanta Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Hospital certification: CCN 112005

Legal name

SELECT SPECIALTY HOSPITAL - NORTHEAST ATLANTA

Certification status

Terminated Voluntary: merger or closure, Apr 5, 2017

Provider type (POS)

Hospital – Long-term

Participating since

Apr 1, 1994

Last certification

Apr 1, 1994

Beds

18

Ownership / control type

Private (not for profit)

Facility address

1821 Clifton Road NE
Atlanta, GA 30329

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

{
    "created_epoch": "1398729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1417651200000",
    "number": "1417367558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4714 GETTYSBURG RD",
            "address_2": "LEGAL DEPT",
            "city": "MECHANICSBURG",
            "state": "PA",
            "postal_code": "170554325",
            "telephone_number": "717-972-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1821 CLIFTON RD NE",
            "address_2": "NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303294021",
            "telephone_number": "404-728-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WWLTACH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-29",
        "last_updated": "2014-12-04",
        "status": "A",
        "authorized_official_last_name": "TARVIN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "717-972-1100"
    },
    "taxonomies": [
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Select Specialty Hospital - Northeast Atlanta",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Meena Devi Wudali, M.D.
• Diane Rosemary Wulfsohn, PHD
• Brandon Michael Wummer, MD
• Katherine Grace Wunderle, CNM, ARNP
• Ginny Wurttemberg, CNM, MSN
• Juanita D Wyatt-Hathaway, M.D.
• Glenn Wyatt III, RBT
• Rochelle Wyche
• Kellie Elise Wydrinski, PAC
• John Bradley Wyly, M.D.

• Long Term Care Hospital in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Long Term Care Hospital in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.