1356447536 NPI number — TIFT COUNTY COMMISSIONER OF ROADS & REVENUES

Table of content: (NPI 1356447536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356447536 NPI number — TIFT COUNTY COMMISSIONER OF ROADS & REVENUES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIFT COUNTY COMMISSIONER OF ROADS & REVENUES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356447536
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1980
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TIFTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31793-1980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-386-7924
Provider Business Mailing Address Fax Number:
229-386-7923

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1209 N TIFTON AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TIFTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-386-7924
Provider Business Practice Location Address Fax Number:
229-386-7923
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHAFIN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
EMS DIRECTOR
Authorized Official Telephone Number:
229-388-6041

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  13701 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 85028359AA . This is a "MEDICARE PTAN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000003077A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com