NPIMap

Organization Active NPI

Allergy & Dermatology Associates of Tifton PC

Doing business as Allergy, Asthma, & Sinsus Clinic

  • Specialist
  • Tifton, GA
National Provider Identifier
1366621211
Registry record updated Jul 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
023352 Issued in GA
Legal business name
ALLERGY & DERMATOLOGY ASSOCIATES OF TIFTON PC
Doing business as
Allergy, Asthma, & Sinsus Clinic
Practice address
820 Love Avenue
Suite a
Tifton, GA 31794
Phone
(229) 382-3720
Fax
(229) 382-3722
NPI assigned
Oct 29, 2007
Last updated
Jul 26, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2013

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

Authorized official

Name
Mr. Henry Clayton Dorminey, M.D.NPI 1689655904
Title
Owner
Phone
(229) 382-3720

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 023352 GA Primary

Addresses

Primary practice location

820 Love Avenue
Suite a
Tifton, GA 31794

Mailing address

820 Love Avenue
Suite a
Tifton, GA 31794
Phone (229) 382-3720

Other identifiers 1

IdentifierTypeStateIssuer
000239731AMedicaidGA

Other names 1

  • Allergy, Asthma, & Sinsus Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

820 Love Ave
Tifton, GA 31794
Phone (912) 382-3720

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1193616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374796800000",
    "number": "1366621211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 LOVE AVENUE",
            "address_2": "SUITE A",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "31794",
            "telephone_number": "229-382-3720",
            "fax_number": "229-382-3722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 LOVE AVENUE",
            "address_2": "SUITE A",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "31794",
            "telephone_number": "229-382-3720",
            "fax_number": "229-382-3722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLERGY & DERMATOLOGY ASSOCIATES OF TIFTON PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-29",
        "last_updated": "2013-07-26",
        "status": "A",
        "authorized_official_last_name": "DORMINEY",
        "authorized_official_first_name": "HENRY",
        "authorized_official_middle_name": "CLAYTON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-382-3720",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "023352",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000239731A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Allergy, Asthma, & Sinsus Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.