Healthcare Provider Details

I. General information

NPI: 1548724941
Provider Name (Legal Business Name): T.I.P ORGANIZATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4412 LIBERTY PKWY
SAVANNAH GA
31405-3732
US

IV. Provider business mailing address

4412 LIBERTY PKWY
SAVANNAH GA
31405-3732
US

V. Phone/Fax

Practice location:
  • Phone: 912-441-4954
  • Fax:
Mailing address:
  • Phone: 191-244-1495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGELA BRANTLEY
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 912-441-4954