Healthcare Provider Details

I. General information

NPI: 1710964614
Provider Name (Legal Business Name): TIFTON ANESTHESIA ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 MADISON AVE
TIFTON GA
31794-3756
US

IV. Provider business mailing address

PO BOX 7348
TIFTON GA
31793-7348
US

V. Phone/Fax

Practice location:
  • Phone: 229-386-5405
  • Fax: 229-386-5571
Mailing address:
  • Phone: 229-388-1378
  • Fax: 229-386-5571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: TONYA H DAVIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 229-388-1378