Provider Demographics
NPI:1568499762
Name:TIFT INTERNAL MEDICINE CTR
Entity Type:Organization
Organization Name:TIFT INTERNAL MEDICINE CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SAVELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-391-3555
Mailing Address - Street 1:907 E 18TH ST
Mailing Address - Street 2:STE 340
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794
Mailing Address - Country:US
Mailing Address - Phone:229-391-3555
Mailing Address - Fax:229-391-3560
Practice Address - Street 1:907 E 18TH ST
Practice Address - Street 2:STE 340
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794
Practice Address - Country:US
Practice Address - Phone:229-391-3555
Practice Address - Fax:229-391-3560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044086207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0401686OtherUNITED HEALTHCARE
GA00760812DMedicaid
GA11BDVMRMedicare ID - Type Unspecified
GA0401686OtherUNITED HEALTHCARE