Organization
TIFT REGIONAL HEALTH SYSTEM INC
Active
Other names
Ocilla Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER DORMAN (PRESIDENT/CEO)
(229) 353-6104
Entity
Organization
Contact information
Practice address
813 N IRWIN AVE, OCILLA, GA 31774-3757
(229) 468-7323
(229) 468-7320
Mailing address
PO BOX 2650, TIFTON, GA 31793-2650
(229) 353-3422
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
064200
GA
Other
Enumeration date
04/24/2015
Last updated
06/24/2022
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