Healthcare Provider Details

I. General information

NPI: 1902722572
Provider Name (Legal Business Name): TIFFANY BOGUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1687 CENTER POINT PKWY
BIRMINGHAM AL
35215-5528
US

IV. Provider business mailing address

2114 COLONY PARK DR
BIRMINGHAM AL
35243-2371
US

V. Phone/Fax

Practice location:
  • Phone: 205-557-7022
  • Fax:
Mailing address:
  • Phone: 205-541-8589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3089G
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: