Healthcare Provider Details

I. General information

NPI: 1649384520
Provider Name (Legal Business Name): SOUTH GEORGIA PHYSICIANS FOR WOMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 GREENFIELD DR
TIFTON GA
31794-3794
US

IV. Provider business mailing address

PO BOX 1189
TIFTON GA
31793-1189
US

V. Phone/Fax

Practice location:
  • Phone: 229-382-8822
  • Fax: 229-387-0377
Mailing address:
  • Phone: 229-382-8822
  • Fax: 229-387-0377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DARRELL JORDAN
Title or Position: DOCTOR
Credential: M.D.
Phone: 229-382-8822