Healthcare Provider Details

I. General information

NPI: 1720996762
Provider Name (Legal Business Name): TIANA DOCTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 BARNARD ST # 640
SAVANNAH GA
31401-6746
US

IV. Provider business mailing address

1305 BARNARD ST # 640
SAVANNAH GA
31401-6746
US

V. Phone/Fax

Practice location:
  • Phone: 843-287-2577
  • Fax:
Mailing address:
  • Phone: 843-287-2577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC016133
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: