Healthcare Provider Details

I. General information

NPI: 1649650896
Provider Name (Legal Business Name): JOSEPH SPEARS TINGEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1348 WALTON WAY STE 5700
AUGUSTA GA
30901-5110
US

IV. Provider business mailing address

PO BOX 1524
AUGUSTA GA
30903-1524
US

V. Phone/Fax

Practice location:
  • Phone: 706-774-7022
  • Fax: 706-774-7023
Mailing address:
  • Phone: 706-854-6008
  • Fax: 706-774-7230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberLL38315S
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number92918
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number92918
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: