Healthcare Provider Details

I. General information

NPI: 1548485436
Provider Name (Legal Business Name): TIFFANY REIGHARD CALDWELL RN, CNOR,RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1646 NEWNAN RD
CARROLLTON GA
30116-6430
US

IV. Provider business mailing address

1646 NEWNAN RD
CARROLLTON GA
30116-6430
US

V. Phone/Fax

Practice location:
  • Phone: 770-265-9436
  • Fax: 770-834-3883
Mailing address:
  • Phone: 770-265-9436
  • Fax: 770-834-3883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN126668
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: