Provider Demographics
NPI:1770247819
Name:BROWN, TIFFANY D
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:D
Last Name:BROWN
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 1:3026 GREELEYVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-6191
Mailing Address - Country:US
Mailing Address - Phone:803-410-8625
Mailing Address - Fax:
Practice Address - Street 1:3026 GREELEYVILLE HWY
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-6191
Practice Address - Country:US
Practice Address - Phone:803-410-8625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver