Provider Demographics
NPI:1083955066
Name:EDWARDS, TIFFANY CECILE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CECILE
Last Name:EDWARDS
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 1:124 HARVEST RDG
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30102-2192
Mailing Address - Country:US
Mailing Address - Phone:404-664-4755
Mailing Address - Fax:
Practice Address - Street 1:124 HARVEST RDG
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30102-2192
Practice Address - Country:US
Practice Address - Phone:404-664-4755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator