Organization
TIFT REGIONAL HEALTH SYSTEM INC.
Active
Other names
Southwell Medical Community Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER DORMAN (PRESIDENT/CEO)
(229) 353-6104
Entity
Organization
Contact information
Practice address
2735 CENTRAL AVE S, TIFTON, GA 31794-5645
(229) 388-5690
(229) 388-5685
Mailing address
PO BOX 2650, TIFTON, GA 31793-2650
(229) 353-3422
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
01/23/2020
Last updated
06/24/2022
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