Provider Demographics
NPI:1700101177
Name:DAVIDSON, TIFFANY DANIELLE (BA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DANIELLE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:DANIELLE
Other - Last Name:WINTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DEPT 888182
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37995-8182
Mailing Address - Country:US
Mailing Address - Phone:800-355-3565
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:2018 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37921-5718
Practice Address - Country:US
Practice Address - Phone:865-544-0406
Practice Address - Fax:865-544-0480
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator