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Tift Regional Health System Inc

Organization Active NPI Family Medicine Physician · Tifton, GA

NPI 1124679014 · NPPES record last updated Jun 24, 2022

Key facts

NPI
1124679014
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
TIFT REGIONAL HEALTH SYSTEM INC
Practice address
39 Kent Rd
Suite 2
Tifton, GA 31794-1697
Phone
(229) 388-9393
Fax
(229) 388-9855
NPI assigned
Sep 23, 2019
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) 18

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

Practitioners 13

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

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 (19 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207Q00000X Yes

Addresses

Primary practice location

39 Kent Rd
Suite 2
Tifton, GA 31794-1697

Mailing address

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

Other names

  • Southwell Center for Healing and Wellness Doing business as

Other providers in Tifton, GA

All providers in Tifton, GA · Family Medicine Physician in Georgia

Sources for this page

Verify at the official NPI Registry.