Provider Demographics
NPI:1306568696
Name:LONGLEY, TIFFANY SUZANNE
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:SUZANNE
Last Name:LONGLEY
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 1:5226 HIGHWAY 76
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705-6363
Mailing Address - Country:US
Mailing Address - Phone:706-980-5980
Mailing Address - Fax:
Practice Address - Street 1:709 OLD DALTON ELLIJAY RD
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-2019
Practice Address - Country:US
Practice Address - Phone:706-370-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist