Provider Demographics
NPI:1003980996
Name:TIFT REGIONAL HEALTH SYSTEM INC
Entity Type:Organization
Organization Name:TIFT REGIONAL HEALTH SYSTEM INC
Other - Org Name:WORKSMART OCCUPATIONAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER ENROLLMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:GLADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-353-3402
Mailing Address - Street 1:4468 UNION RD
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-8331
Mailing Address - Country:US
Mailing Address - Phone:229-353-6320
Mailing Address - Fax:229-353-6343
Practice Address - Street 1:4468 UNION RD
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-8331
Practice Address - Country:US
Practice Address - Phone:229-353-6320
Practice Address - Fax:229-353-6343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA137-180261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA137-180OtherLICENSE NUMBER