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General NPI Number Information
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NPI Number | 1013315605
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Entity Type | Organization
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Legal Business Name | TIFT COUNTY HOSPITAL AUTHORITY
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Dates
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Enumeration Date | 12/12/2014
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Last Update Date | 12/12/2014
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Provider Practice Location Address
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Address Line | 246 BEN HILL DRIVE
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City | FITZGERALD
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State | GA
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Zip | 31750
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Country | US
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Telephone | 229-423-2400
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Fax | 229-423-2472
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Provider Business Mailing Address
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Address Line | 907 18TH ST E SUITE 150
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City | TIFTON
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State | GA
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Zip | 31794-3643
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Country | US
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Telephone | 229-423-2400
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Fax |
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Authorized Official
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Title or Position | VP PHYSICIAN SERVICES
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Name | LINDA A WILSON
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Credential |
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Telephone | 229-353-3403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 030071
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License Number State | GA
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