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Organization
TIFTON CLINIC LLC
Active
Organization
TIFTON CLINIC LLC
Active
Parent organization
COLQUITT REGIONAL MEDICAL INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
COLQUITT REGIONAL MEDICAL INC
Authorized official
WENDELL L SIMS (COO)
(229) 890-3531
Entity
Organization
Contact information
Practice address
1623 OLD OCILLA RD, TIFTON, GA 31794-4173
(229) 891-9131
Mailing address
PO BOX 2876, MOULTRIE, GA 31776-2876
(229) 891-9131
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
11/19/2014
Last updated
11/19/2014
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