Provider Demographics
NPI:1003645896
Name:DAVIS, TIFFANY RENEE (EDD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RENEE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1984
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37011-1984
Mailing Address - Country:US
Mailing Address - Phone:931-994-4442
Mailing Address - Fax:
Practice Address - Street 1:608 WHIRLAWAY DR
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-5477
Practice Address - Country:US
Practice Address - Phone:931-994-4244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator