Individual
DR. WILLIAM C TIDMORE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2418 N OAK ST, VALDOSTA, GA 31602-2576
(229) 219-0247
(229) 219-0837
Mailing address
2418 N OAK ST, VALDOSTA, GA 31602-2576
(229) 219-0247
(229) 219-0837
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
041978
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00701027C
—
GA
05
—
00701027G
—
GA
Enumeration date
10/19/2006
Last updated
09/08/2020
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