NPIMap

Organization Active NPI

Southwell Ambulatory Inc

  • Multi-Specialty Clinic/Center
  • Tifton, GA
National Provider Identifier
1306466206
Registry record updated Oct 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
SOUTHWELL AMBULATORY INC
Practice address
901 18TH St E
Tifton, GA 31794-3648
Phone
(229) 382-7120
NPI assigned
Apr 21, 2020
Last updated
Oct 27, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2025

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

Authorized official

Name
Troy Brooks
Title
SVP/Cfo
Phone
(229) 353-3397

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

901 18TH St E
Tifton, GA 31794-3648

Mailing address

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200224001260 GA Part B Supplier - Clinic/Group Practice 9234566779 Receives reassigned benefits from 16 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Adel, GA; Valdosta, GA; Tifton, GA

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Southwell Ambulatory Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1587427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761523200000",
    "number": "1306466206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2650",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317932650",
            "telephone_number": "229-353-3422",
            "fax_number": "229-391-4059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 18TH ST E",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943648",
            "telephone_number": "229-382-7120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWELL AMBULATORY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-21",
        "last_updated": "2025-10-27",
        "certification_date": "2025-10-27",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "TROY",
        "authorized_official_title_or_position": "SVP/CFO",
        "authorized_official_telephone_number": "229-353-3397"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "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 Oct 27, 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.