Provider Demographics
NPI:1619698693
Name:ROBERTS, TIFFANY N
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:N
Last Name:ROBERTS
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 1:6741 CHURCH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2249
Mailing Address - Country:US
Mailing Address - Phone:470-278-2333
Mailing Address - Fax:
Practice Address - Street 1:6741 CHURCH ST STE 3
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2249
Practice Address - Country:US
Practice Address - Phone:470-278-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor