Provider Demographics
NPI:1780098756
Name:TIDWELL, NATHAN (DO)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:TIDWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 BLUFF AVE # 29841
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3862
Mailing Address - Country:US
Mailing Address - Phone:803-624-1313
Mailing Address - Fax:803-426-9236
Practice Address - Street 1:150 BLUFF AVE # 29841
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3862
Practice Address - Country:US
Practice Address - Phone:803-624-1313
Practice Address - Fax:803-426-9236
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA75019207RH0003X
GA075019207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine