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General NPI Number Information
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NPI Number | 1831298660
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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 | 09/21/2006
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 1010 EDGEFIELD DR
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City | TIFTON
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State | GA
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Zip | 31794-2408
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Country | US
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Telephone | 229-353-6208
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Fax | 229-353-7722
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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 | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 137-180
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License Number State | GA
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