Provider Demographics
NPI:1457629651
Name:CAVINESS, TIAH
Entity Type:Individual
Prefix:
First Name:TIAH
Middle Name:
Last Name:CAVINESS
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 1:5710 K HIGH POINT RD
Mailing Address - Street 2:181
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407
Mailing Address - Country:US
Mailing Address - Phone:336-283-0404
Mailing Address - Fax:
Practice Address - Street 1:5710 K HIGH POINT RD
Practice Address - Street 2:181
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407
Practice Address - Country:US
Practice Address - Phone:336-283-0404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-02
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7873102343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC453819207Medicaid