Provider Demographics
NPI:1386813400
Name:SMITH, TIFFANY ANN
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:SMITH
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 1:9445 GA HIGHWAY 315
Mailing Address - Street 2:
Mailing Address - City:CATAULA
Mailing Address - State:GA
Mailing Address - Zip Code:31804-2801
Mailing Address - Country:US
Mailing Address - Phone:706-341-5000
Mailing Address - Fax:
Practice Address - Street 1:1727 BOXWOOD PL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-2328
Practice Address - Country:US
Practice Address - Phone:706-569-0727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health