Provider Demographics
NPI:1821281494
Name:TIFT REGIONAL HEALTH SYSTEM INC
Entity Type:Organization
Organization Name:TIFT REGIONAL HEALTH SYSTEM INC
Other - Org Name:ARTHRITIS AND OSTEOPOROSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-353-6104
Mailing Address - Street 1:PO BOX 2650
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-2650
Mailing Address - Country:US
Mailing Address - Phone:229-353-3422
Mailing Address - Fax:
Practice Address - Street 1:2227 US HIGHWAY 41 N
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-2749
Practice Address - Country:US
Practice Address - Phone:229-391-3320
Practice Address - Fax:229-391-3325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RR0500X
GA044028305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
No305R00000XManaged Care OrganizationsPreferred Provider OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000752056BMedicaid
GA1053498840OtherNPI-GEORGIA GRIFFIS, PA
GA1902871965OtherNPI-JESSICA L HART, PA
GA000752056EMedicaid
GA1437390101OtherNPI-TROY SPICER, JR, NP
GA1720195837OtherNPI/ JAME E MOSSELL, III
GA1720195837OtherNPI/ JAME E MOSSELL, III
GA000752056BMedicaid