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General NPI Number Information
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NPI Number | 1134188634
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Entity Type | Organization
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Legal Business Name | TIFT COUNTY BOARD OF HEALTH D/B/A DIVERSIFIED ENTERPRISES
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 08/08/2011
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Provider Practice Location Address
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Address Line | 192 VIRGINIA AVE S SUITE 100
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City | TIFTON
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State | GA
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Zip | 31794-8074
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Country | US
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Telephone | 229-386-3560
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Fax | 229-386-7156
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Provider Business Mailing Address
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Address Line | 192 VIRGINIA AVE S SUITE 100
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City | TIFTON
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State | GA
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Zip | 31794-8074
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Country | US
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Telephone | 229-386-3560
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Fax | 229-386-7156
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Authorized Official
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Title or Position | WEB PORTAL MANAGER
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Name | THERESA DURDEN
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Credential |
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Telephone | 229-391-6867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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