MEDICARE: DR. ANSLEY TIDWELL PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835C0205X	Critical Care Pharmacist	RPH029197	GA

General Provider Information

NPI Number	:	1881557692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANSLEY TIDWELL PHARMD

Provider Business Mailing Address
First Line	:	477 WILMER ST NE UNIT 2406
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2996
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 PEACHTREE ST NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-2212
Country	:	US
Telephone Number	:	404-819-9568
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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