Healthcare Provider Details

I. General information

NPI: 1700721529
Provider Name (Legal Business Name): TIFT REGIONAL HEALTH SYSTEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N IRWIN AVE STE A
OCILLA GA
31774-5007
US

IV. Provider business mailing address

PO BOX 2650
TIFTON GA
31793-2650
US

V. Phone/Fax

Practice location:
  • Phone: 229-468-7323
  • Fax: 229-468-7320
Mailing address:
  • Phone: 229-353-3422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER DORMAN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 229-353-6121