NPIMap

Organization Active NPI

Serena D. Tidwell, M.D., P.C.

Doing business as Midtown OB GYN

  • Point of Service
  • Columbus, GA
National Provider Identifier
1689759581
Registry record updated Jan 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Point of ServiceTaxonomy code 305S00000X
License
051192 Issued in GA
Legal business name
SERENA D. TIDWELL, M.D., P.C.
Doing business as
Midtown OB GYN
Practice address
1538 13TH Ave
Suite C200
Columbus, GA 31901-1956
Phone
(706) 320-2547
Fax
(706) 320-2549
NPI assigned
Oct 26, 2006
Last updated
Jan 20, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2015

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

Authorized official

Name
Dr. Serena Davis Tidwell, M.D.NPI 1033141031
Title
President
Phone
(706) 320-2547

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Point of Service 305S00000X 051192 GA Primary

Addresses

Primary practice location

1538 13TH Ave
Suite C200
Columbus, GA 31901-1956

Mailing address

1538 13TH Ave
Suite C200
Columbus, GA 31901-1956
Phone (706) 320-2547

Other names 1

  • Midtown OB GYN Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070816000161 GA Part B Supplier - Clinic/Group Practice 9931291226 Receives reassigned benefits from 18 practitioners
Practice locations: Columbus, GA; Locust Grove, GA; Stockbridge, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D1010631Midtown OB GYN1538 13TH Avenue Suite C-200, Columbus, GA 31901Certificate of waiverJan 24, 2027

National Provider Directory

National Provider Directory

Locations

1538 13th Ave
Ste B200
Columbus, GA 31901
Phone (706) 320-2547

3081 Williams Rd
Unit A
Columbus, GA 31909
Phone (706) 320-2547

3081 Williams Rd
Unit B200
Columbus, GA 31909
Phone (706) 320-2547

5040 Bill Gardner Pkwy
Ste 200
Locust Grove, GA 30248
Phone (770) 474-0064

115 Eagle Spring Dr
Ste A200
Stockbridge, GA 30281
Phone 7704740064 ext. 108

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421712000000",
    "number": "1689759581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1538 13TH AVE",
            "address_2": "SUITE C200",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319011956",
            "telephone_number": "706-320-2547",
            "fax_number": "706-320-2549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1538 13TH AVE",
            "address_2": "SUITE C200",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319011956",
            "telephone_number": "706-320-2547",
            "fax_number": "706-320-2549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENA D. TIDWELL, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2015-01-20",
        "status": "A",
        "authorized_official_last_name": "TIDWELL",
        "authorized_official_first_name": "SERENA",
        "authorized_official_middle_name": "DAVIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-320-2547",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "GA",
            "license": "051192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midtown OB GYN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbus, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.