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General NPI Number Information
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NPI Number | 1437331006
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Entity Type | Organization
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Legal Business Name | TIFTON ORTHOPAEDIC CLINIC, PC
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Dates
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Enumeration Date | 12/05/2007
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Last Update Date | 12/05/2007
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Provider Practice Location Address
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Address Line | 1622 MADISON AVE
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City | TIFTON
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State | GA
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Zip | 31794-3756
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Country | US
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Telephone | 229-386-0888
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Fax | 229-386-2245
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Provider Business Mailing Address
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Address Line | 1622 MADISON AVENUE
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City | TIFTON
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State | GA
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Zip | 31794-1228
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Country | US
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Telephone | 229-386-0888
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Fax | 229-386-2245
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM L HORNBACK III
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Credential | M.D.
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Telephone | 229-386-0888
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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 | 20741
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License Number State | GA
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