Leslie G Tidwell, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

44359 Issued in GA

Practice address

3448 Vineville Ave
Macon, GA 31204-1867

Phone

(478) 405-0045

Fax

(478) 405-0054

NPI assigned

May 28, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vineville Internal Medicine LLC

  • Internal Medicine Physician
  • Macon, GA
  • NPI 1396955431
  Medicare reassignment NPD
• Central Georgia Gynecology LLC

  • Gynecology Physician
  • Macon, GA
  • NPI 1407015365

  Obstetrics & Gynecology

  NPD (past)
• Cornerstone Medical Assoc., LLC

  • Pediatrics Physician
  • Perry, GA
  • NPI 1275575888
  NPD (past)
• Guardian Medical Services, LLC

  • Certified Registered Nurse Anesthetist
  • Macon, GA
  • NPI 1255786521
  NPD (past)
• Personal Recovery Network LLC

  • Psychiatry Physician
  • Stockbridge, GA
  • NPI 1881990869
  NPD (past)

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1568419216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3448 VINEVILLE AVE",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312041867",
            "telephone_number": "478-405-0045",
            "fax_number": "478-405-0054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3448 VINEVILLE AVE",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312041867",
            "telephone_number": "478-405-0045",
            "fax_number": "478-405-0054"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 S Houston Lake Rd",
            "address_purpose": "LOCATION",
            "city": "Warner Robins",
            "state": "GA",
            "postal_code": "310889006",
            "country_code": "US",
            "telephone_number": "478-953-1800",
            "fax_number": "478-953-1931",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "LESLIE",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-28",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "44359",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "44359",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000866907A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000866907B",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "202I169707",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN",
            "identifier": "GRP7599",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaley Peacock Thrasher, NP
• Three Rivers Home Health Services, Inc.
• Andrew Tice, MD
• Alyson Tidwell
• Cameron Austin Tidwell, NP-C
• William L Tift, M.D.
• Patricia Kelly Tillery, PHARMD
• Christopher Tillitski, PH.D.
• Judith J. Tillman, RN, MSN, NP-C
• Lisa Ann Tillman, NP-C

• Family Medicine Physician in Macon, GA
• Providers in Macon, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.