Provider Demographics
NPI:1083110597
Name:NEALY, TIFFANY (MD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:NEALY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:JEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 746550
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6550
Mailing Address - Country:US
Mailing Address - Phone:888-236-2263
Mailing Address - Fax:844-307-2857
Practice Address - Street 1:33 REBECCA DR
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:VA
Practice Address - Zip Code:22963-6242
Practice Address - Country:US
Practice Address - Phone:434-654-4680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8378851207Q00000X
NC238850207Q00000X
VA0101273658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine