Organization
TIFT COUNTY BOARD OF HEALTH D/B/A DIVERSIFIED ENTERPRISES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA DURDEN (WEB PORTAL MANAGER)
(229) 386-3122
Entity
Organization
Contact information
Practice address
192 VIRGINIA AVE S STE 100, TIFTON, GA 31794-8000
(229) 386-3122
(229) 386-7156
Mailing address
192 VIRGINIA AVE S STE 100, TIFTON, GA 31794-8000
(229) 386-3122
(229) 386-7156
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
000609771BN
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000609771BN
—
GA
Enumeration date
06/06/2011
Last updated
06/06/2011
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