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General NPI Number Information
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NPI Number | 1184204414
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Entity Type | Organization
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Legal Business Name | SOUTHERN BLESSINGS ADULT AND PEDIATRICS LLC
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Dates
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Enumeration Date | 04/12/2021
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Last Update Date | 04/12/2021
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Provider Practice Location Address
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Address Line | 1402 PINEVIEW RD
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City | JASPER
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State | AL
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Zip | 35504-8906
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Country | US
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Telephone | 606-302-1233
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Fax |
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Provider Business Mailing Address
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Address Line | 1402 PINEVIEW RD
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City | JASPER
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State | AL
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Zip | 35504-8906
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Country | US
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Telephone | 606-302-1233
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Fax |
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Authorized Official
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Title or Position | OWNER/CRNP
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Name | TIFFANY TOLLIVER
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Credential | CRNP
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Telephone | 606-302-1233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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