| Leslie G Tidwell, MD | |
|
3448 Vineville Ave, Macon, GA 31204-1867 | |
| (478) 405-0045 | |
| (478) 405-0054 |
| Full Name | Leslie G Tidwell |
|---|---|
| Gender | Female |
| Speciality | Family Medicine |
| Location | 3448 Vineville Ave, Macon, Georgia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568419216 | NPI | - | NPPES |
| 000866907A | Medicaid | GA | |
| 000866907B | Medicaid | GA | |
| 202I169707 | Other | GA | MEDICARE ID |
| GRP7599 | Other | GA | MEDICARE PIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207V00000X | Obstetrics & Gynecology | 44359 (Georgia) | Secondary |
| 207Q00000X | Family Medicine | 44359 (Georgia) | Primary |
| Entity Name | Vineville Internal Medicine Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1396955431 PECOS PAC ID: 0941281711 Enrollment ID: O20060223000410 |
| Mailing Address | Practice Location Address |
|---|---|
| Leslie G Tidwell, MD 3448 Vineville Ave, Macon, GA 31204-1867 Ph: (478) 405-0045 | Leslie G Tidwell, MD 3448 Vineville Ave, Macon, GA 31204-1867 Ph: (478) 405-0045 |
Dr. Shuichi Nakai, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 3780 Eisenhower Pkwy, Macon, GA 31206 Phone: 478-633-5550 Fax: 478-633-7287 | |
Kamilya Hunter, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 3780 Eisenhower Pkwy, Macon, GA 31206 Phone: 478-633-5500 Fax: 478-784-5496 | |
Dr. Robert C Jones, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 3200 Riverside Dr Ste B300, Macon, GA 31210 Phone: 478-405-5252 Fax: 478-477-8411 | |
Alice Rose House, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 1550 College St, Suite A, Macon, GA 31207 Phone: 478-301-4111 Fax: 478-301-5812 | |
Dione Duc, Family Medicine Medicare: Medicare Enrolled Practice Location: 777 Hemlock St # 104, Macon, GA 31201 Phone: 478-633-7550 Fax: 478-633-3235 | |
Collier Branan Gladin Jr., M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 140 N Crest Blvd, Macon, GA 31210 Phone: 478-757-8335 Fax: 478-757-8353 | |
Mrs. Cynthia Blair Chambless, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 197 Bass Rd, Macon, GA 31210 Phone: 478-477-0966 Fax: 478-254-3146 |