Provider Demographics
NPI:1982845897
Name:BOLDEN-WATKINS, TIFFANY L (MD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:L
Last Name:BOLDEN-WATKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-8003
Mailing Address - Country:US
Mailing Address - Phone:912-490-2229
Mailing Address - Fax:912-490-9023
Practice Address - Street 1:505 CITY BLVD
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-8003
Practice Address - Country:US
Practice Address - Phone:912-490-2229
Practice Address - Fax:912-490-9023
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-23
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302780207V00000X
LAMD.206395207V00000X
390200000X
GA69677207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program