Provider Demographics
NPI:1629580600
Name:GILES, TIFFANY DENISE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DENISE
Last Name:GILES
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 1:2714 WATERFORD CLUB DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-4413
Mailing Address - Country:US
Mailing Address - Phone:470-755-6710
Mailing Address - Fax:
Practice Address - Street 1:4595 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-4317
Practice Address - Country:US
Practice Address - Phone:470-755-6710
Practice Address - Fax:470-755-6710
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health