Organization
TIFT REGIONAL HEALTH SYSTEM, INC.
Active
Other names
Cook Primary Care, Southwell Medical Adel Primary Care
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER DORMAN (PRESIDENT/CEO)
(229) 353-6104
Entity
Organization
Contact information
Practice address
172 MJ TAYLOR RD, ADEL, GA 31620-3497
(229) 896-8500
(229) 896-8503
Mailing address
PO BOX 2650, TIFTON, GA 31793-2650
(229) 353-3422
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003109531A
—
GA
Enumeration date
03/03/2010
Last updated
06/24/2022
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