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General NPI Number Information
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NPI Number | 1073989596
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Entity Type | Individual
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Provider Name | TIFFANY SAMUEL
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Gender | Female
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 08/19/2015
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Provider Practice Location Address
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Address Line | 415 N JACKSON ST
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City | AMERICUS
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State | GA
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Zip | 31709-3015
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Country | US
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Telephone | 229-931-2470
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Fax |
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Provider Business Mailing Address
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Address Line | 519 W STEWART ST
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City | QUITMAN
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State | GA
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Zip | 31643-2647
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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