Tiftarea Pediatrics

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

TIFTAREA PEDIATRICS

Practice address

215 12TH St W
Tifton, GA 31794-3923

Phone

(912) 690-4043

NPI assigned

Dec 30, 2021

Organization subpart

No

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

Authorized official

Name

Mark Wilson, MDNPI 1003132754

Title

Co-Owner

Phone

(229) 396-5335

Specialties & licenses 1

Addresses

Locations

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

• Mark Davis Wilson, M.D.

  • Pediatrics Physician
  • Tifton, GA
  • NPI 1003132754

  Pediatrics

  NPD Authorized official
• Elizabeth L. Wilson, PNP

  • Pediatric Nurse Practitioner
  • Tifton, GA
  • NPI 1093080541
  NPD

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

CLIA laboratory certificates

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

{
    "created_epoch": "1640822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667347200000",
    "number": "1154081271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 12TH ST W",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943923",
            "telephone_number": "912-690-4043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 12TH ST W",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943923",
            "telephone_number": "912-690-4043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIFTAREA PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-30",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "229-396-5335",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tift Regional Health System, Inc.
• Tift Regional Health System, Inc.
• Tift Regional Medical Center
• Tiftarea Cardiology
• Tiftarea Endoscopy Center, Inc.
• Tiftarea Psychiatric and Counseling Services, LLC
• Tiftarea Surgical Partners, LLC
• Tiftarea Urology, PC
• Tifton Addiction Associates, LLC. D/B/a TLC Clinic
• Tifton Anesthesia Associates, P.C.

• All providers in Tifton, GA
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.