Individual
DR. REX WALLACE TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1601 WATSON BLVD., HOUSTON MEDICAL CENTER, WARNER ROBINS, GA 31093
(478) 542-7996
(478) 542-7943
Mailing address
11811 GA HIGHWAY 74, FORSYTH, GA 31029-7409
(478) 994-9877
(478) 992-9362
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
010300
GA
Other
Enumeration date
11/27/2006
Last updated
07/08/2007
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