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General NPI Number Information
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NPI Number | 1053487462
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Entity Type | Organization
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Legal Business Name | TIFTAREA CARDIOLOGY
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 04/04/2012
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Provider Practice Location Address
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Address Line | 907 E. 18TH ST STE 100
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City | TIFTON
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State | GA
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Zip | 31794
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Country | US
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Telephone | 229-391-9980
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Fax | 229-391-9984
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Provider Business Mailing Address
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Address Line | 907 E. 18TH ST STE 100
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City | TIFTON
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State | GA
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Zip | 31794
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Country | US
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Telephone | 229-391-9980
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Fax | 229-391-9984
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Authorized Official
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Title or Position | OWNER/MD
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Name | WILLIAM WALTER HANCOCK
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Credential | MD
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Telephone | 229-391-9980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 047089
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 047089
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License Number State | GA
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