MEDICARE: TIFT REGIONAL HEALTH SYSTEM INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1588294045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIFT REGIONAL HEALTH SYSTEM INC.

Provider Business Mailing Address
First Line	:	PO BOX 2650
Second Line	:
City	:	TIFTON
State	:	GA
Zip	:	31793-2650
Country	:	US
Telephone Number	:	229-353-3422
Fax Number	:

Provider Business Practice Location Address
First Line	:	416 E MCPHERSON AVE STE A
Second Line	:
City	:	NASHVILLE
State	:	GA
Zip	:	31639-2277
Country	:	US
Telephone Number	:	229-686-2093
Fax Number	:	229-686-7150

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	CHRISTOPHER DORMAN
Credential	:
Telephone Number	:	229-353-6104

Provider Enumeration Date	:	01/23/2020
Last Update Date	:	06/24/2022

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