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General NPI Number Information
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NPI Number | 1821281494
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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 | 08/27/2007
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Last Update Date | 06/27/2022
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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 | 229-391-3320
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Fax | 229-391-3325
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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 | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 044028
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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