Healthcare Provider Details

I. General information

NPI: 1053487462
Provider Name (Legal Business Name): TIFTAREA CARDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 E. 18TH ST STE 100
TIFTON GA
31794
US

IV. Provider business mailing address

907 E. 18TH ST STE 100
TIFTON GA
31794
US

V. Phone/Fax

Practice location:
  • Phone: 229-391-9980
  • Fax: 229-391-9984
Mailing address:
  • Phone: 229-391-9980
  • Fax: 229-391-9984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number047089
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number047089
License Number StateGA

VIII. Authorized Official

Name: WILLIAM WALTER HANCOCK
Title or Position: OWNER/MD
Credential: MD
Phone: 229-391-9980