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SOUTHWELL MEDICAL ASHBURN PRIMARY CARE
NPI 1063042562
Clinic/Center - Rural Health in Ashburn, GA

Active since January 23, 2020CLIA 11D0912925 · Waiver
611 E WASHINGTON AVE, ASHBURN, GA 31714(229) 567-3407(229) 567-4467 Get Directions Write a Review

NPPES record last updated: June 24, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jun 2, 2021, Jan 23, 2020 (2 updates tracked since 2020).

About Southwell Medical Ashburn Primary Care NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHWELL MEDICAL ASHBURN PRIMARY CARE (NPI 1063042562) is a healthcare organization registered as a rural health in Ashburn, Georgia and active in the NPI registry since January 2020. The organization holds a CLIA Waiver certificate valid through March 14, 2028 and lists Christopher Dorman, President/ceo, as its authorized official.

NPPES Registry Identity

NPI1063042562
Entity TypeOrganization
Primary Taxonomy261QR1300X
Legal Business NameTIFT REGIONAL HEALTH SYSTEM INC
Location Address611 E WASHINGTON AVEAshburn, GA 31714-5315
Mailing AddressPo Box 2650Tifton, GA 31793-2650 · (229) 353-3422
Phone(229) 567-3407
Fax(229) 567-4467
Organization SubpartNo
Authorized OfficialChristopher DormanPresident/ceo · (229) 353-6104
Enumeration DateJanuary 23, 2020
Last NPPES UpdateJune 24, 20222 updates tracked since enumeration
NPPES CertifiedJune 24, 2022
✔ NPI 1063042562 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Rural HealthAmbulatory Health Care Facilities
Taxonomy Code261QR1300X
Also ListedFamily MedicineTaxonomy 207Q00000X
611 E WASHINGTON AVE, Ashburn, GA 31714
Open in Google Maps ↗

Other Names 1

Doing Business AsSouthwell Medical Ashburn Primary Care

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D0912925

Southwell Medical Ashburn Primary Care · Ashburn, GA
Active · expires Mar 14, 2028
CLIA Number11D0912925
Laboratory TypeRural Health Clinic
Certificate Effective DateMarch 15, 2026
Certificate Expiration DateMarch 14, 2028
Laboratory DirectorVincent Valencia
Laboratory Phone(229) 353-6121
Laboratory LocationSouthwell Medical Ashburn Primary Care611 East Washington Ave, Ashburn, GA 31714
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JOHN W. DESIMONE MD
Family Medicine
611 E WASHINGTON AVE
ASHBURN, GA 31714
Turner County (229) 567-3407
MARIEL DANITA HEPBURN
Family Medicine
611 E WASHINGTON AVE
ASHBURN, GA 31714
Turner County (229) 567-3407

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tift Regional Health System Inc's NPI number?

The NPI number for Tift Regional Health System Inc is 1063042562. It was assigned to this organization in the NPPES registry on January 23, 2020. The provider is doing business as Southwell Medical Ashburn Primary Care.

Where is Tift Regional Health System Inc located?

Tift Regional Health System Inc is located at 611 E Washington Ave, Ashburn, GA 31714. The listed phone number is (229) 567-3407.

What is Tift Regional Health System Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.

Does Tift Regional Health System Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D0912925) is associated with this NPI, valid through March 14, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Tift Regional Health System Inc accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama and Ambetter of North Carolina and 1 other insurer list Tift Regional Health System Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Tift Regional Health System Inc was last updated on June 24, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.