Provider Demographics
NPI:1891979340
Name:TITUS, TISHA MARIE (MD, MPH)
Entity Type:Individual
Prefix:
First Name:TISHA
Middle Name:MARIE
Last Name:TITUS
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 BOULEVARD DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-1502
Mailing Address - Country:US
Mailing Address - Phone:678-949-9360
Mailing Address - Fax:
Practice Address - Street 1:1044 BOULEVARD DR NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-1502
Practice Address - Country:US
Practice Address - Phone:678-949-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-19
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN463002083P0901X
GA604802083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN26 000 2270OtherMPIN
MNH 96553Medicare UPIN