Provider Demographics
NPI:1710964614
Name:TIFTON ANESTHESIA ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:TIFTON ANESTHESIA ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:H
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-388-1378
Mailing Address - Street 1:PO BOX 7348
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-7348
Mailing Address - Country:US
Mailing Address - Phone:229-388-1378
Mailing Address - Fax:229-386-5571
Practice Address - Street 1:1602 MADISON AVE
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3756
Practice Address - Country:US
Practice Address - Phone:229-386-5405
Practice Address - Fax:229-386-5571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA760Medicare ID - Type UnspecifiedGROUP NUMBER