Provider Demographics
NPI:1073283255
Name:MAHEIA, TIFFANI (PA-C)
Entity type:Individual
Prefix:
First Name:TIFFANI
Middle Name:
Last Name:MAHEIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4347 FAWN LN SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-3952
Mailing Address - Country:US
Mailing Address - Phone:708-846-9957
Mailing Address - Fax:
Practice Address - Street 1:980 JOHNSON FY RD NE STE 170
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1607
Practice Address - Country:US
Practice Address - Phone:404-300-2140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA363A00000X
GA10419363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant