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General NPI Number Information
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NPI Number | 1134225501
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Entity Type | Organization
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Legal Business Name | TIFTON FAMILY MEDICINE, PC
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 11/12/2007
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Provider Practice Location Address
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Address Line | 902 18TH ST EAST
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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 | 229-382-6414
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Fax |
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Provider Business Mailing Address
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Address Line | 3025 BRECKINRIDGE BLVD SUITE 120
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City | DULUTH
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State | GA
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Zip | 30096
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Country | US
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Telephone | 678-226-0022
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARCUS C ROBERTS
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Credential | M.D.
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Telephone | 229-382-6414
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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 | 035986
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License Number State | GA
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