NPIMap

Organization Active NPI

Tift Regional Dental Group, PC

  • General Practice Dentistry
  • Tifton, GA
National Provider Identifier
1851460075
Registry record updated Sep 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
TIFT REGIONAL DENTAL GROUP, PC
Practice address
209 24TH St E
Tifton, GA 31794-3170
Phone
(229) 382-0467
NPI assigned
Nov 6, 2006
Last updated
Sep 12, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2008

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

Authorized official

Name
Angela Waller
Title
Secretary
Phone
(229) 382-0467

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X GA Primary

Addresses

Primary practice location

209 24TH St E
Tifton, GA 31794-3170

Mailing address

PO Box 1295
Tifton, GA 31793-1295
Phone (229) 382-0467

Other identifiers 2

IdentifierTypeStateIssuer
40104MedicaidGA
111718MedicaidGA

National Provider Directory

National Provider Directory

Locations

209 24th St E
Tifton, GA 31794
Phone (229) 382-0467

Practitioners & affiliated clinicians

Practitioners 4

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": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221177600000",
    "number": "1851460075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1295",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317931295",
            "telephone_number": "229-382-0467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 24TH ST E",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943170",
            "telephone_number": "229-382-0467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIFT REGIONAL DENTAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2008-09-12",
        "status": "A",
        "authorized_official_last_name": "WALLER",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "229-382-0467"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40104",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111718",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Sep 12, 2008; 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.