Provider Demographics
NPI:1235225822
Name:TIPPETT, JAMES T (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:TIPPETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 COMMERCE DR STE 106
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-7447
Mailing Address - Country:US
Mailing Address - Phone:706-510-3659
Mailing Address - Fax:762-445-1081
Practice Address - Street 1:1210 COMMERCE DR STE 106
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642
Practice Address - Country:US
Practice Address - Phone:706-999-0243
Practice Address - Fax:706-999-0245
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2018-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA19792207R00000X
GA019792207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D31026Medicare UPIN
GA11SCDPQMedicare ID - Type Unspecified