Provider Demographics
NPI:1184597189
Name:MARTIN, TIFFANY T
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:T
Last Name:MARTIN
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 1:83 ERNEST BARRETT PKWY UNIT 1201
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3494
Mailing Address - Country:US
Mailing Address - Phone:678-977-7484
Mailing Address - Fax:
Practice Address - Street 1:83 ERNEST BARRETT PKWY UNIT 1201
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3494
Practice Address - Country:US
Practice Address - Phone:678-977-7484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant