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General NPI Number Information
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NPI Number | 1396095428
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Entity Type | Organization
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Legal Business Name | TIFT REGIONAL HEALTH SYSTEM INC
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Dates
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Enumeration Date | 09/17/2012
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 2227 US HIGHWAY 41 N
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City | TIFTON
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State | GA
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Zip | 31794-2749
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Country | US
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Telephone | 229-386-4200
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Fax | 229-386-5571
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Provider Business Mailing Address
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Address Line | PO BOX 2650
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City | TIFTON
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State | GA
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Zip | 31793-2650
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Country | US
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Telephone | 229-353-3422
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | CHRISTOPHER DORMAN
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Credential |
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Telephone | 229-353-6104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 026452
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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