Healthcare Provider Details

I. General information

NPI: 1164999033
Provider Name (Legal Business Name): TIFFANY A. REAMS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 04/28/2025
Certification Date: 04/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 PRINCE AVE STE 300
ATHENS GA
30606-5814
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 706-425-1470
  • Fax:
Mailing address:
  • Phone: 239-343-7130
  • Fax: 239-343-7185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12831
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9111472
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: