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General NPI Number Information
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NPI Number | 1457943813
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Entity Type | Individual
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Provider Name | TIFFANY TAMAIRA BATES APRN
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Gender | Female
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Dates
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Enumeration Date | 02/08/2021
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Last Update Date | 11/06/2025
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Provider Practice Location Address
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Address Line | 175 CORPORATE CENTER DR STE B
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7382
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Country | US
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Telephone | 470-436-0847
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Fax |
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Provider Business Mailing Address
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Address Line | 175 CORPORATE CENTER DR STE B
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7382
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Country | US
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Telephone | 470-275-2358
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN219825
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | RN219825
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN219825
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License Number State | GA
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