Organization
TIFT COUNTY BOARD OF HEALTH D/B/A DIVERSIFIED ENTERPRISES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRIE DURDEN (WEB PORTAL MANAGER)
(229) 386-3122
Entity
Organization
Contact information
Practice address
192 VIRGINIA AVE S, SUITE 100, TIFTON, GA 31794-8074
(229) 386-3560
(229) 386-7156
Mailing address
192 S. VIGINIA AVE., SUITE 100, TIFTON, GA 31794
(229) 386-3560
(229) 386-7156
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000609771BR
—
GA
Enumeration date
03/07/2012
Last updated
03/07/2012
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