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General NPI Number Information
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NPI Number | 1922043009
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Entity Type | Individual
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Provider Name | GORDON H. TWEDT M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2309 MASTERS CT
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City | ALBANY
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State | GA
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Zip | 31721-2073
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Country | US
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Telephone | 229-894-4688
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Fax | 229-883-1579
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Provider Business Mailing Address
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Address Line | 2309 MASTERS CT
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City | ALBANY
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State | GA
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Zip | 31721-2073
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Country | US
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Telephone | 229-894-4688
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Fax | 229-883-1579
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 032830
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License Number State | GA
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