MEDICARE: DR. TIFFANIE LASHAUN GARRISON-JETER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	9488	TN
2	1223G0001X	General Practice Dentistry	9488	TN

General Provider Information

NPI Number	:	1578811667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIFFANIE LASHAUN GARRISON-JETER DMD

Provider Business Mailing Address
First Line	:	6998 OLD CUSSETA RD
Second Line	:
City	:	FORT BENNING
State	:	GA
Zip	:	31905-5431
Country	:	US
Telephone Number	:	706-544-3176
Fax Number	:	706-544-1933

Provider Business Practice Location Address
First Line	:	6998 OLD CUSSETA RD
Second Line	:
City	:	FORT BENNING
State	:	GA
Zip	:	31905-5431
Country	:	US
Telephone Number	:	706-544-3176
Fax Number	:	706-544-1933

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2012
Last Update Date	:	05/24/2016

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