Individual
DR. CHRISTOPHER K TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1538 13TH AVE, C100, COLUMBUS, GA 31901-1595
(706) 494-7000
(706) 494-7011
Mailing address
1538 13TH AVENUE, SUITE C100, COLUMBUS, GA 31901-1595
(706) 494-7000
(706) 494-7011
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
054351
GA
207RP1001X
Pulmonary Disease Physician
Primary
054351
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
551575810A
—
GA
Enumeration date
08/20/2006
Last updated
04/06/2016
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