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General NPI Number Information
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NPI Number | 1881541332
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Entity Type | Individual
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Provider Name | TIFFANY NICOLE PETTIFORD
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Gender | Female
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Dates
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Enumeration Date | 03/13/2026
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Last Update Date | 03/13/2026
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Provider Practice Location Address
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Address Line | 1035 RED BUD RD NE
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City | CALHOUN
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State | GA
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Zip | 30701-6010
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Country | US
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Telephone | 706-602-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 3344 COBB PKWY NW SUITE 200 PMB 1154
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City | ACWORTH
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State | GA
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Zip | 30101-8345
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Country | US
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Telephone | 770-680-0874
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 283799
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License Number State | GA
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