Individual
AUSTIN TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
33-57 HARRISON ST, JOHNSON CITY, NY 13790-2107
(607) 763-6674
Mailing address
33-57 HARRISON ST, JOHNSON CITY, NY 13790-2107
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
14843
CA
208M00000X
Hospitalist Physician
Primary
14843
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/25/2014
Last updated
05/25/2022
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