Healthcare Provider Details

I. General information

NPI: 1487333480
Provider Name (Legal Business Name): TIFFANY L CAWTHON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 OLD MILL RD STE 100
LAGRANGE GA
30241-6704
US

IV. Provider business mailing address

106 OLD MILL RD STE 100
LAGRANGE GA
30241-6704
US

V. Phone/Fax

Practice location:
  • Phone: 706-803-8500
  • Fax:
Mailing address:
  • Phone: 706-803-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN238306
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: