Provider Demographics
NPI:1427645449
Name:DEGELIA, TIFFENY (SR CPHT)
Entity type:Individual
Prefix:
First Name:TIFFENY
Middle Name:
Last Name:DEGELIA
Suffix:
Gender:F
Credentials:SR CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3888 VINEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-1865
Mailing Address - Country:US
Mailing Address - Phone:478-471-6744
Mailing Address - Fax:478-471-9936
Practice Address - Street 1:3888 VINEVILLE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-1865
Practice Address - Country:US
Practice Address - Phone:478-471-6744
Practice Address - Fax:478-471-9936
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116300183700000X
GAPHTC026162183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician