NPIMap

Tift Regional Health System Inc

Organization Active NPI Nephrology Physician · Tifton, GA

NPI 1053933754 · NPPES record last updated Jun 24, 2022

Key facts

NPI
1053933754
Entity type
Organization (NPI type 2)
Primary specialty
Nephrology Physician 207RN0300X
Legal business name
TIFT REGIONAL HEALTH SYSTEM INC
Practice address
39 Kent Rd Ste 1
Tifton, GA 31794-1697
Phone
(229) 391-4310
Fax
(229) 391-4243
NPI assigned
May 15, 2020
Organization subpart
No

Authorized official

Name
Christopher Dorman
Title
President/Ceo
Phone
(229) 353-6104

Other NPIs on the same Medicare enrollment 23

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Corporate family (same tax ID) 19

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2192188Southwell Nephrology
39 Kent Road, Suite 1, Tifton, GA 31794		Certificate of waiverSep 7, 2026

Medicare participation

Medicare fee-for-service enrollment
Enrolled in GA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20200217002409 GA Part B Supplier - Clinic/Group Practice 2062745169 Receives reassigned benefits from 389 practitioners
33 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tifton, GA; Adel, GA

National Provider Directory

Tax ID family
Tift Regional Health System Inc (20 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207RN0300X Yes

Addresses

Primary practice location

39 Kent Rd Ste 1
Tifton, GA 31794-1697

Mailing address

PO Box 2650
Tifton, GA 31793-2650
Phone (229) 353-3422

Other names

  • Southwell Nephrology Doing business as

Other providers in Tifton, GA

All providers in Tifton, GA · Nephrology Physician in Georgia

Sources for this page

Verify at the official NPI Registry.