Provider Demographics
NPI:1912296302
Name:HILL, TIFFANY LE'SHAUN
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:LE'SHAUN
Last Name:HILL
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 1:335 ROSELANE ST NW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7902
Mailing Address - Country:US
Mailing Address - Phone:470-259-5226
Mailing Address - Fax:267-321-2044
Practice Address - Street 1:800 W ARBROOK BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-4327
Practice Address - Country:US
Practice Address - Phone:817-472-2200
Practice Address - Fax:817-467-9021
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1154498261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX456013ZR2BMedicare PIN
TX456006Medicare PIN