Provider Demographics
NPI:1063390508
Name:CHADWICK, TIFFANY JOHNSON
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:JOHNSON
Last Name:CHADWICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 N MEDICAL PARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703-7240
Mailing Address - Country:US
Mailing Address - Phone:662-378-3117
Mailing Address - Fax:662-378-3191
Practice Address - Street 1:1907 N MEDICAL PARK DR STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-7240
Practice Address - Country:US
Practice Address - Phone:662-378-3191
Practice Address - Fax:662-378-3191
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies