Healthcare Provider Details

I. General information

NPI: 1407734437
Provider Name (Legal Business Name): TIFFANY LEAH HAMMOND CST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 COMMONWEALTH DR
GREENVILLE SC
29615-4812
US

IV. Provider business mailing address

1050 GROVE RD
GREENVILLE SC
29605-4698
US

V. Phone/Fax

Practice location:
  • Phone: 864-675-4539
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number184068
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: