Organization
TIFTON CLINIC LLC
Active
Parent organization
COLQUITT REGIONAL MEDICAL INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
COLQUITT REGIONAL MEDICAL INC
Authorized official
WENDELL L SIMS (COO)
(229) 890-3531
Entity
Organization
Contact information
Practice address
1623 OLD OCILLA RD, TIFTON, GA 31794-4173
(229) 891-9131
Mailing address
PO BOX 2876, MOULTRIE, GA 31776-2876
(229) 891-9131
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
11/19/2014
Last updated
11/19/2014
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