Provider Demographics
NPI:1972824712
Name:STANFILL, TIFFANY L (MD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:STANFILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:L
Other - Last Name:STANFILL THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:706 DIXIE ST STE 220
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3819
Mailing Address - Country:US
Mailing Address - Phone:770-838-8710
Mailing Address - Fax:770-812-5735
Practice Address - Street 1:690 DALLAS HWY
Practice Address - Street 2:SUITE 301
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1264
Practice Address - Country:US
Practice Address - Phone:770-812-3850
Practice Address - Fax:770-456-3826
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA071171207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003138180BMedicaid