# NW GA REGIONAL HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** STATE OF GEORGIA DEPARTMENT OF HUMAN RESOURCES
- **Other names:** Pharmacy
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1003939794
- **Legal business name:** STATE OF GEORGIA DEPARTMENT OF HUMAN RESOURCES
- **Authorized official:** TAMMY VAUGHN (PATIENT ACCOUNTS OFFICER)
- **Authorized official phone:** (706) 295-6298

## Contact information

- **Practice address:** 705 N DIVISION ST NW, ROME, GA 30165-1454
- **Practice address phone:** (706) 295-6298
- **Mailing address:** 705 N DIVISION ST NW, PATIENT ACCOUNTS OFFICE, ROME, GA 30165-1454

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336I0012X | Institutional Pharmacy | — | — | Yes |

## Other

- **Enumeration date:** 04/09/2007
- **Last updated:** 06/23/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000355748A | — | GA |
| 01 | — | 114014 | MEDICARE PROVIDER NUMBER | GA |