Individual
DR. THOMAS JACKSON TIDWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2121 WARM SPRINGS RD STE B, COLUMBUS, GA 31904-7954
(706) 660-8121
(706) 323-4205
Mailing address
2121 WARM SPRINGS RD STE B, COLUMBUS, GA 31904-7954
(706) 660-8121
(706) 323-4205
Taxonomy
Speciality
Code
Description
License number
State
261QX0203X
Radiation Oncology Clinic/Center
Primary
18964
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300028978A
—
GA
Enumeration date
10/04/2006
Last updated
10/16/2009
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