Healthcare Provider Details

I. General information

NPI: 1396095428
Provider Name (Legal Business Name): TIFT REGIONAL HEALTH SYSTEM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2227 US HIGHWAY 41 N
TIFTON GA
31794-2749
US

IV. Provider business mailing address

PO BOX 2650
TIFTON GA
31793-2650
US

V. Phone/Fax

Practice location:
  • Phone: 229-386-4200
  • Fax: 229-386-5571
Mailing address:
  • Phone: 229-353-3422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number026452
License Number StateGA

VIII. Authorized Official

Name: CHRISTOPHER DORMAN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 229-353-6104