Provider Demographics
NPI:1497049225
Name:HAILSTORKS, TIFFANY PATRICE (MD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:PATRICE
Last Name:HAILSTORKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 MECASLIN ST NW APT 1317
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-5567
Mailing Address - Country:US
Mailing Address - Phone:202-498-0157
Mailing Address - Fax:
Practice Address - Street 1:49 JESSE HILL JR DR SE OFC BLDG
Practice Address - Street 2:EMORY UNIVERSITY SCHOOL OF MEDICINE, DEPT OF GYN&OB
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3049
Practice Address - Country:US
Practice Address - Phone:202-498-0157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA73966207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology