Provider Demographics
NPI:1245073584
Name:MUHAMMAD, TIFFANY
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:MUHAMMAD
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 1:155 WESTRIDGE PKWY STE 225C7
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3049
Mailing Address - Country:US
Mailing Address - Phone:770-258-6765
Mailing Address - Fax:678-348-7103
Practice Address - Street 1:155 WESTRIDGE PKWY STE 225
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3052
Practice Address - Country:US
Practice Address - Phone:770-258-6765
Practice Address - Fax:678-348-7103
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3747P1801X, 247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant