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General NPI Number Information
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NPI Number | 1134418445
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Entity Type | Organization
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Legal Business Name | TIFTON CARDIOVASCULAR,LLC
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Dates
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Enumeration Date | 04/07/2011
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Last Update Date | 02/09/2025
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Provider Practice Location Address
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Address Line | 1499 KENNEDY RD STE C
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City | TIFTON
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State | GA
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Zip | 31794-4177
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Country | US
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Telephone | 229-238-3034
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Fax | 229-238-3027
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Provider Business Mailing Address
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Address Line | 39 KENT ROAD, SUITE 1
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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 | 229-391-3555
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Fax | 229-238-3027
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JUDY A SHIFLET
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Credential |
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Telephone | 229-238-3034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 054042
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License Number State | GA
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