Tidwell, Leslie G

Tidwell, Leslie G is an individual health care provider with primary practice located at 3448 Vineville Ave , Macon GA 31204-1867. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Tidwell, Leslie G can be contacted via phone (478) 405-0045.

Contact Information

Primary practice address
3448 Vineville Ave Macon GA 31204-1867
Phone: (478) 405-0045
Fax: (478) 405-0054
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 44359 Georgia
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 44359 Georgia

Profile Details

NPI number 1568419216
LBN Legal business name Tidwell, Leslie G
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 28th, 2006
Last updated Mar 17th, 2018 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568419216 NPPES
Georgia MEDICAID 000866907A
Georgia MEDICAID 000866907B
Georgia Other 202I169707
Georgia Other GRP7599

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