Provider Demographics
NPI:1407613763
Name:TIFFANY ADULT WELLNESS AND WEIGHT LOSS LLC
Entity Type:Organization
Organization Name:TIFFANY ADULT WELLNESS AND WEIGHT LOSS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:646-272-8417
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:SC
Mailing Address - Zip Code:29816-0247
Mailing Address - Country:US
Mailing Address - Phone:839-777-8052
Mailing Address - Fax:
Practice Address - Street 1:3100 DICK POND RD UNIT E
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7286
Practice Address - Country:US
Practice Address - Phone:839-777-8052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center