Organization
TIFTON ENDOSCOPY CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELAINE CLEGHORN (BUSINESS ADMINISTRATOR)
(229) 382-9338
Entity
Organization
Contact information
Practice address
1111 20TH ST E, TIFTON, GA 31794-3689
(229) 382-9338
(229) 382-4282
Mailing address
1111 20TH ST E, TIFTON, GA 31794-3689
(229) 382-9338
(229) 382-4282
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
111094ASCA
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00755675A
—
GA
Enumeration date
09/22/2006
Last updated
07/16/2019
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