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General NPI Number Information
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NPI Number | 1568499762
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Entity Type | Organization
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Legal Business Name | TIFT INTERNAL MEDICINE CTR
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 907 E 18TH ST STE 340
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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 | 229-391-3560
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Provider Business Mailing Address
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Address Line | 907 E 18TH ST STE 340
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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 | 229-391-3560
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | BRENT ALAN SAVELLI
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Credential | MD
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Telephone | 229-391-3555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 044086
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License Number State | GA
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