Organization
TIFT REGIONAL HEALTH SYSTEM INC
Active
Other names
Southwell School Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER DORMAN (PRESIDENT/CEO)
(229) 353-6104
Entity
Organization
Contact information
Practice address
1464 CARPENTER ROAD S, TIFTON, GA 31793
(229) 353-2227
(229) 388-9515
Mailing address
PO BOX 2650, TIFTON, GA 31793-2650
(229) 353-3422
Taxonomy
Speciality
Code
Description
License number
State
363LS0200X
School Nurse Practitioner
Primary
—
—
Other
Enumeration date
07/01/2019
Last updated
06/24/2022
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