Provider Demographics
NPI:1023201555
Name:BROWN, TIFFANY D (OD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:D
Last Name:BROWN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4480H S COBB DR SE STE 124
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6958
Mailing Address - Country:US
Mailing Address - Phone:770-743-6971
Mailing Address - Fax:770-743-8224
Practice Address - Street 1:2427 GRESHAM RD SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-3709
Practice Address - Country:US
Practice Address - Phone:770-743-6971
Practice Address - Fax:678-490-8224
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1547 576T152W00000X
GA2395152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
202I417335OtherMEDICARE PROVIDER TRANSACTION ACCESS NUMBER
MS08786318Medicaid
LA1014982Medicaid
GA003126245AMedicaid
MS08786318Medicaid