Healthcare Provider Details

I. General information

NPI: 1841883188
Provider Name (Legal Business Name): TIFFANY E. MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 ATLANTA HWY STE 109
ALPHARETTA GA
30004-8798
US

IV. Provider business mailing address

4080 MCGINNIS FERRY RD STE 301
ALPHARETTA GA
30005-1737
US

V. Phone/Fax

Practice location:
  • Phone: 770-217-3499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2830652
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: