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General NPI Number Information
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NPI Number | 1003980996
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Entity Type | Organization
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Legal Business Name | TIFT REGIONAL HEALTH SYSTEM INC
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 11/21/2023
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Provider Practice Location Address
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Address Line | 4468 UNION RD
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City | TIFTON
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State | GA
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Zip | 31794-8331
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Country | US
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Telephone | 229-353-6320
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Fax | 229-353-6343
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Provider Business Mailing Address
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Address Line | 4468 UNION RD
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City | TIFTON
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State | GA
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Zip | 31794-8331
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Country | US
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Telephone | 229-353-6320
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Fax | 229-353-6343
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT MANAGER
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Name | KRISTY GLADDEN
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Credential |
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Telephone | 229-353-3402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 137-180
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License Number State | GA
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