Provider Demographics
NPI:1437597176
Name:BATES, TIFFANY SIERRA (DO)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:SIERRA
Last Name:BATES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:SIERRA
Other - Last Name:BILLUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-377-5675
Mailing Address - Fax:704-335-8163
Practice Address - Street 1:8820 RACHEL FREEMAN WAY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278
Practice Address - Country:US
Practice Address - Phone:704-316-7770
Practice Address - Fax:704-316-7771
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-02134207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology