Provider Demographics
NPI:1316423437
Name:EVERETT, TIFFANY TINESE (MA, PP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:TINESE
Last Name:EVERETT
Suffix:
Gender:F
Credentials:MA, PP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 6TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39828-2131
Mailing Address - Country:US
Mailing Address - Phone:229-421-4333
Mailing Address - Fax:
Practice Address - Street 1:201 6TH AVE NE
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39828-2131
Practice Address - Country:US
Practice Address - Phone:229-421-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor