Healthcare Provider Details

I. General information

NPI: 1992738199
Provider Name (Legal Business Name): TIFT HEALTH CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 TIFT AVE N
TIFTON GA
31794-1824
US

IV. Provider business mailing address

PO BOX 1668
TIFTON GA
31793-1668
US

V. Phone/Fax

Practice location:
  • Phone: 229-382-7342
  • Fax: 229-382-5577
Mailing address:
  • Phone: 229-382-7342
  • Fax: 229-382-5577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1137704
License Number StateGA

VIII. Authorized Official

Name: DAVIS W KING
Title or Position: PRESIDENT
Credential:
Phone: 229-639-0021