Individual
LESLIE G TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3448 VINEVILLE AVE, MACON, GA 31204-1867
(478) 405-0045
(478) 405-0054
Mailing address
3448 VINEVILLE AVE, MACON, GA 31204-1867
(478) 405-0045
(478) 405-0054
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
44359
GA
207V00000X
Obstetrics & Gynecology Physician
44359
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000866907A
—
GA
05
—
000866907B
—
GA
01
—
202I169707
MEDICARE ID
GA
01
—
GRP7599
MEDICARE PIN
GA
Enumeration date
05/28/2006
Last updated
03/17/2018
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us