Basic Information
| Provider Information | |||||||||
| NPI: | 1609262773 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TIFT COUNTY HOSPITAL AUTHORITY | ||||||||
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| OtherOrganizationName: | GEORGIA MUSCULOSKELETAL INSTITUTE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 907 18TH ST E | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | TIFTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317943643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2293865222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1610 JOHN ORR DR | ||||||||
| Address2: | |||||||||
| City: | TIFTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 317943682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2293865222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2015 | ||||||||
| LastUpdateDate: | 04/15/2015 | ||||||||
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| AuthorizedOfficialLastName: | WILSON | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | VP PHYSICIAN SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 2293533403 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 015420 | GA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.