Healthcare Provider Details

I. General information

NPI: 1548784390
Provider Name (Legal Business Name): TIFFANY B LANGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BAPTIST DR STE 204
MADISON MS
39110-2011
US

IV. Provider business mailing address

401 BAPTIST DR STE 204
MADISON MS
39110-2011
US

V. Phone/Fax

Practice location:
  • Phone: 601-973-1583
  • Fax: 601-973-1609
Mailing address:
  • Phone: 601-973-1583
  • Fax: 601-973-1609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA4345
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: