Individual
DR. STEPHEN CRAIG TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1105 BURLEYSON RD, DALTON, GA 30720-3017
(706) 278-4640
(706) 275-6599
Mailing address
1105 BURLEYSON RD, DALTON, GA 30720-3017
(706) 278-4640
(706) 275-6599
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
046332
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00812743A
—
GA
Enumeration date
09/26/2006
Last updated
10/11/2011
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