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General NPI Number Information
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NPI Number | 1467333658
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Entity Type | Individual
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Provider Name | TIFFANY THEARA LONG
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Gender | Female
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Dates
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Enumeration Date | 09/12/2025
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 3660 MARKETPLACE BLVD
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City | EAST POINT
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State | GA
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Zip | 30344-5738
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Country | US
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Telephone | 404-642-3248
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Fax |
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Provider Business Mailing Address
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Address Line | 9413 DEER CROSSING DR
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City | JONESBORO
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State | GA
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Zip | 30236-5194
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Country | US
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Telephone | 404-642-3248
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH035805
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License Number State | GA
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