Organization
TIFTON OPHTHALMOLOGY ASSOCIATES. PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY R MOORMAN M.D. (OWNER)
(229) 386-2181
Entity
Organization
Contact information
Practice address
1803 OLD OCILLA RD, TIFTON, GA 31794-1617
(229) 386-2181
(229) 386-2193
Mailing address
1803 OLD OCILLA RD, TIFTON, GA 31794-1617
(229) 386-2181
(229) 386-2193
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300022683A
—
GA
01
—
CC44356
RAILROAD MEDICARE
GA
01
—
GRP2612
GEORGIA MEDICARE
GA
Enumeration date
11/18/2014
Last updated
11/18/2014
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