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907 18th St E Suite 140 Tifton GA 31794-3643 | |
(229) 353-4325 | |
Not Available |
Full Name | |
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Speciality | Clinic/center |
Location | 907 18th St E, Tifton, Georgia |
Authorized Official Name and Position | Christopher Dorman (PRESIDENT/CEO) |
Authorized Official Contact | 2293536104 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 2650 Tifton GA 31793-2650 Ph: (229) 353-3422 | 907 18th St E Suite 140 Tifton GA 31794-3643 Ph: (229) 353-4325 |
NPI Number | 1306244090 |
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Provider Enumeration Date | 12/11/2014 |
Last Update Date | 06/24/2022 |
Identifier | Type | State | Issuer |
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1306244090 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | 031888 (Georgia) | Primary |
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