NPIMap

Organization Active NPI

Tift Regional Health System, Inc

Doing business as Southwell Medical Clinic

  • Multi-Specialty Clinic/Center
  • Tifton, GA
National Provider Identifier
1861022329
Registry record updated Sep 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
TIFT REGIONAL HEALTH SYSTEM, INC
Doing business as
Southwell Medical Clinic
Practice address
2225 US Highway 41 N
Tifton, GA 31794-2749
Phone
(229) 391-4100
Fax
(229) 391-4508
NPI assigned
Jan 23, 2020
Last updated
Sep 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2025

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

Authorized official

Name
Christopher Dorman
Title
President/Ceo
Phone
(229) 353-6104

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology Physician 207K00000X NU
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU
Cardiovascular Disease Physician 207RC0000X NU
Gastroenterology Physician 207RG0100X NU
Pulmonary Disease Physician 207RP1001X NU
Psychiatry Physician 2084P0800X NU
Multi-Specialty Clinic/Center 261QM1300X NU Primary

Addresses

Primary practice location

2225 US Highway 41 N
Tifton, GA 31794-2749

Mailing address

PO Box 2650
Tifton, GA 31793-2650
Phone (229) 353-3422

Other practice location 1

1111 20th St E
Tifton, GA 31794-3689
Phone (229) 391-4030

Other names 1

  • Southwell Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200217002409 GA Part B Supplier - Clinic/Group Practice 2062745169 Receives reassigned benefits from 389 practitioners
33 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tifton, GA; Adel, GA

Other NPIs on the same Medicare enrollment 23

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 23

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
11D0988576Tift Regional Health System, Inc2225 US Highway 41 N, Tifton, GA 31794AccreditationDec 13, 2027
11D1094282Tift Regional Health Systems, Inc2225 US Highway 41 North, Tifton, GA 31794Provider-performed microscopyNov 16, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

901 18th St E
Tifton, GA 31794
Phone (229) 353-6208

Interoperability endpoints

  • Direct secure messaging: anthony.burke@trhs.cernerdirect.com
  • Direct secure messaging: brittney.berckman1@trhs.cernerdirect.com
  • Direct secure messaging: cameron.nixon@trhs.cernerdirect.com
  • Direct secure messaging: dawn.floyd@trhs.cernerdirect.com
  • Direct secure messaging: emily.hawsey@trhs.cernerdirect.com
  • Direct secure messaging: haiden.edore@trhs.cernerdirect.com
  • Direct secure messaging: james.graham@trhs.cernerdirect.com
  • Direct secure messaging: jerry.sullivan@trhs.cernerdirect.com
  • Direct secure messaging: jian.li@trhs.cernerdirect.com
  • Direct secure messaging: kyle.woods@trhs.cernerdirect.com
  • Direct secure messaging: laurie.gautney@trhs.cernerdirect.com
  • Direct secure messaging: margaret.richardsonnixon@trhs.cernerdirect.com
  • Direct secure messaging: michael.perri@trhs.cernerdirect.com
  • Direct secure messaging: robert.hawes@trhs.cernerdirect.com
  • Direct secure messaging: rubal.patel@trhs.cernerdirect.com
  • Direct secure messaging: steve.rigdon@trhs.cernerdirect.com

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1579737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756857600000",
    "number": "1861022329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2650",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317932650",
            "telephone_number": "229-353-3422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 US HIGHWAY 41 N",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317942749",
            "telephone_number": "229-391-4100",
            "fax_number": "229-391-4508"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1111 20th St E",
            "address_purpose": "LOCATION",
            "city": "Tifton",
            "state": "GA",
            "postal_code": "317943689",
            "country_code": "US",
            "telephone_number": "229-391-4030",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TIFT REGIONAL HEALTH SYSTEM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-23",
        "last_updated": "2025-09-03",
        "certification_date": "2025-09-03",
        "status": "A",
        "authorized_official_last_name": "DORMAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "229-353-6104"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southwell Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southwell Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 3, 2025; 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.