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1205902749
REX WALLACE TIDWELL
WARNER ROBINS, GA
NPI
1205902749
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
2085R0202X Radiology Diagnostic Radiology
(Licence: GA 010300)
Enumeration Date
2006-11-27
Last Update Date
2007-07-08
Business Address
DR. REX WALLACE TIDWELL M.D.
1601 WATSON BLVD. HOUSTON MEDICAL CENTER
WARNER ROBINS, GA 31093
Phone number: 478-542-7996
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Mailing Address
DR. REX WALLACE TIDWELL M.D.
11811 GA HIGHWAY 74
FORSYTH, GA 31029-7409
Phone number: 478-994-9877
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