| Southwell Ambulatory Inc | |
|
901 18th St E Tifton GA 31794-3648 | |
| (229) 382-7120 | |
| Not Available |
| Full Name | Southwell Ambulatory Inc |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 901 18th St E, Tifton, Georgia |
| Authorized Official Name and Position | Troy Brooks (SVP/CFO) |
| Authorized Official Contact | 2293533397 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southwell Ambulatory Inc 907 18th St E Ste 400 Tifton GA 31794-3684 Ph: (229) 353-3422 | Southwell Ambulatory Inc 901 18th St E Tifton GA 31794-3648 Ph: (229) 382-7120 |
| NPI Number | 1306466206 |
|---|---|
| Provider Enumeration Date | 04/21/2020 |
| Last Update Date | 10/18/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306466206 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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