NPIMap

Organization Active NPI

Southwell Pharmacy

Doing business as Tift Regional Employee Pharmacy

  • Community/Retail Pharmacy
  • Tifton, GA
National Provider Identifier
1407911613
Registry record updated Aug 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
SOUTHWELL PHARMACY
Practice address
1802 Lee Avenue
Tifton, GA 31794
Phone
(229) 353-6756
Fax
(229) 353-6531
NPI assigned
Dec 27, 2006
Last updated
Aug 13, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
TIFT REGIONAL HEALTH SYSTEM, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 13, 2025

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

Authorized official

Name
Christopher Keith Dorman
Title
Ceo
Phone
(229) 382-7120

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

1802 Lee Avenue
Tifton, GA 31794

Mailing address

1802 Lee Avenue
Tifton, GA 31794
Phone (229) 353-6756

Other identifiers 2

IdentifierTypeStateIssuer
1117539OtherOTHER ID NUMBER-COMMERCIAL NUMBER
PHRE010721OtherGALICENSE

Other names 1

  • Tift Regional Employee Pharmacy Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Tift Regional Health System Inc19 organizations share this tax ID, including this one
Part of
Tift Regional Health System Inc

Other organizations with this tax ID 18

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

View all 18

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": "1167177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755043200000",
    "number": "1407911613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1802 LEE AVENUE",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "31794",
            "telephone_number": "229-353-6756",
            "fax_number": "229-353-6531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1802 LEE AVENUE",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "31794",
            "telephone_number": "229-353-6756",
            "fax_number": "229-353-6531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWELL PHARMACY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TIFT REGIONAL HEALTH SYSTEM, INC.",
        "enumeration_date": "2006-12-27",
        "last_updated": "2025-08-13",
        "certification_date": "2023-01-25",
        "status": "A",
        "authorized_official_last_name": "DORMAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "229-382-7120"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1117539",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PHRE010721",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tift Regional Employee Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tift Regional Employee Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tift Regional Employee Pharmacy",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Aug 13, 2025; 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.