Tidwell, Thomas Jackson

Tidwell, Thomas Jackson is an sole proprietor health care provider with primary practice located at 2121 Warm Springs Rd Ste B , Columbus GA 31904-7954. He recently has only one registered license in Ambulatory Health Care Facilities / Oncology, Radiation, which is considered as his primary health care specialty. Tidwell, Thomas Jackson can be contacted via phone (706) 660-8121.

Contact Information

Primary practice address
2121 Warm Springs Rd Ste B Columbus GA 31904-7954
Phone: (706) 660-8121
Fax: (706) 323-4205
Website:
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Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Oncology, Radiation 261QX0203X 18964 Georgia

Profile Details

NPI number 1578658670
LBN Legal business name Tidwell, Thomas Jackson
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 4th, 2006
Last updated Oct 16th, 2009 - about 17 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 1578658670 NPPES
Georgia MEDICAID 300028978A

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