Organization Active NPI

Tifton Cardiovascular,LLC

  • Specialist
  • Tifton, GA
National Provider Identifier
1134418445
Registry record updated Feb 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
054042 Issued in GA
Legal business name
TIFTON CARDIOVASCULAR,LLC
Practice address
1499 Kennedy Rd Ste C
Tifton, GA 31794-4177
Phone
(229) 238-3034
Fax
(229) 238-3027
NPI assigned
Apr 7, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Judy A Shiflet
Title
Office Manager
Phone
(229) 238-3034

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 054042 GA Primary

Addresses

Primary practice location

1499 Kennedy Rd Ste C
Tifton, GA 31794-4177

Mailing address

39 Kent Road, Suite 1
Tifton, GA 31794
Phone (229) 391-3555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110531000405 GA Part B Supplier - Clinic/Group Practice 5092992016 Receives reassigned benefits from 1 practitioner
Practice locations: Tifton, GA

National Provider Directory

National Provider Directory

Locations

1499 Kennedy Rd
Ste C
Tifton, GA 31794
Phone (229) 238-3034

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1302134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739059200000",
    "number": "1134418445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 KENT ROAD, SUITE 1",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "31794",
            "telephone_number": "229-391-3555",
            "fax_number": "229-238-3027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1499 KENNEDY RD STE C",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317944177",
            "telephone_number": "229-238-3034",
            "fax_number": "229-238-3027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIFTON CARDIOVASCULAR,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-07",
        "last_updated": "2025-02-09",
        "certification_date": "2025-02-09",
        "status": "A",
        "authorized_official_last_name": "SHIFLET",
        "authorized_official_first_name": "JUDY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "229-238-3034"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "054042",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tifton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.