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General NPI Number Information
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NPI Number | 1154586667
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Entity Type | Organization
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Legal Business Name | MBS CONNECTION LLC
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Dates
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Enumeration Date | 07/24/2008
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Last Update Date | 09/27/2009
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Provider Practice Location Address
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Address Line | 3400 MCCLURE BRIDGE RD BLDG F, STE A
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City | DULUTH
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State | GA
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Zip | 30096-6675
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Country | US
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Telephone | 678-371-6463
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 956901
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City | DULUTH
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State | GA
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Zip | 30095-9516
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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 | OWNER
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Name | TIFFANY H TAFT
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Credential | LMT
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Telephone | 678-371-6463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | MT000400
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License Number State | GA
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