Provider Demographics
NPI:1619976891
Name:DELICE, TIFFANY M (MD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:M
Last Name:DELICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:M
Other - Last Name:KUMPEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:111 N PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31601-5515
Mailing Address - Country:US
Mailing Address - Phone:229-219-1831
Mailing Address - Fax:229-219-1832
Practice Address - Street 1:111 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-5515
Practice Address - Country:US
Practice Address - Phone:229-219-1831
Practice Address - Fax:229-219-1832
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0544482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA940567216FMedicaid
GA940567216FMedicaid
GA202I263545Medicare PIN
GA202G703547Medicare PIN