Provider Demographics
NPI:1588538037
Name:THOMAS, TIFFANIE
Entity type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:
Last Name:THOMAS
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 1:842 SON WRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:DIXIE
Mailing Address - State:GA
Mailing Address - Zip Code:31629-2717
Mailing Address - Country:US
Mailing Address - Phone:229-415-8310
Mailing Address - Fax:
Practice Address - Street 1:4829 DRY LAKE RD
Practice Address - Street 2:
Practice Address - City:DIXIE
Practice Address - State:GA
Practice Address - Zip Code:31629-3205
Practice Address - Country:US
Practice Address - Phone:229-415-8310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker