Provider Demographics
NPI:1013229830
Name:BRIGHT, TIFFANY SCAVO (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:SCAVO
Last Name:BRIGHT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:MARIE
Other - Last Name:SCAVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:902 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-3344
Mailing Address - Country:US
Mailing Address - Phone:478-987-1610
Mailing Address - Fax:973-965-4580
Practice Address - Street 1:902 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-3344
Practice Address - Country:US
Practice Address - Phone:478-987-1610
Practice Address - Fax:973-965-4580
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007042235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003105610AMedicaid