# TIFTON CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** COLQUITT REGIONAL MEDICAL INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1841696879
- **Legal business name:** COLQUITT REGIONAL MEDICAL INC
- **Authorized official:** WENDELL L SIMS (COO)
- **Authorized official phone:** (229) 890-3531

## Contact information

- **Practice address:** 1623 OLD OCILLA RD, TIFTON, GA 31794-4173
- **Practice address phone:** (229) 891-9131
- **Mailing address:** PO BOX 2876, MOULTRIE, GA 31776-2876
- **Mailing address phone:** (229) 891-9131

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/19/2014
- **Last updated:** 11/19/2014