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Organization

TIFTAREA ENDOSCOPY CENTER, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MICHAEL J. DAWSON M.D. (PRESIDENT)
(229) 391-3625
Entity
Organization

Contact information

Practice address
907 E. 18TH STREET, SUITE 460, TIFTON, GA 31794
(229) 391-3625
(229) 391-3639
Mailing address
907 E. 18TH STREET, SUITE 460, TIFTON, GA 31794
(229) 391-3625
(229) 391-3639

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
136-156
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00818892A
GA
01
136156
DHR LICENSE
GA
Enumeration date
07/03/2006
Last updated
07/14/2010
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