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:
Health care specialties
| Specialty | Code | License # | 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 15 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1578658670 | NPPES |
| Georgia | MEDICAID | 300028978A |
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