| Doctor Name: | LESLIE G TIDWELL |
| NPI Number: | 1568419216 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | 044359 |
| Business Practice Address: | 200 S Houston Lake Rd Warner Robins, GA - 310889006 |
| Business Phone Number: | 4789531800 |
| Business Fax Number: | 4789531931 |
| Mailing Address: | 3448 Vineville Ave, MACON |
| State: | GA |
| Postal Code: | 312041867 |
| Phone Number: | 4784050045 |
| Fax Number: | 4784050054 |
| NPI Enumeration Date: | 05/28/2006 |
| NPI Last Update Date: | 07/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | 044359 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |