Provider Demographics
NPI:1598780546
Name:HALL, TIFFANY (MD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:DEPT 362
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0362
Mailing Address - Country:US
Mailing Address - Phone:901-367-9001
Mailing Address - Fax:901-255-5223
Practice Address - Street 1:3725 CHAMPION HILLS DR STE 2000
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-0502
Practice Address - Country:US
Practice Address - Phone:901-367-9001
Practice Address - Fax:901-565-8787
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36781207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR99182OtherBCBS
AR107001001Medicaid
MS04735812Medicaid
TN4108593OtherBCBS
TNH79276Medicare UPIN
AR107001001Medicaid