Tiftarea Endoscopy Center, Inc.

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

136-156 Issued in GA

Legal business name

TIFTAREA ENDOSCOPY CENTER, INC.

Practice address

907 E. 18TH Street
Suite 460
Tifton, GA 31794

Phone

(229) 391-3625

Fax

(229) 391-3639

NPI assigned

Jul 3, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Michael J. Dawson, M.D.

Title

President

Phone

(229) 391-3625

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1279065600000",
    "number": "1508896705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 E. 18TH STREET",
            "address_2": "SUITE 460",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "31794",
            "telephone_number": "229-391-3625",
            "fax_number": "229-391-3639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 E. 18TH STREET",
            "address_2": "SUITE 460",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "31794",
            "telephone_number": "229-391-3625",
            "fax_number": "229-391-3639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIFTAREA ENDOSCOPY CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2010-07-14",
        "status": "A",
        "authorized_official_last_name": "DAWSON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "229-391-3625",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "136-156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00818892A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DHR LICENSE",
            "identifier": "136156",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• All providers in Tifton, GA
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2010; 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.