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General NPI Number Information
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NPI Number | 1588663686
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Entity Type | Individual
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Provider Name | RAYMOND EUGENE TIDMAN MD
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Gender | Male
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 04/01/2008
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Provider Practice Location Address
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Address Line | 101 RIVERSTONE VIS SUITE 205
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City | BLUE RIDGE
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State | GA
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Zip | 30513-6648
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Country | US
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Telephone | 706-632-4400
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Fax | 706-632-4404
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Provider Business Mailing Address
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Address Line | 101 RIVERSTONE VIS
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City | BLUE RIDGE
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State | GA
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Zip | 30513-6648
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Country | US
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Telephone | 706-632-4400
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Fax | 706-632-4404
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 032826
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License Number State | GA
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