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NPI Code Detail

MEDICARE: TIFFANY ANN SMITH

MEDICARE: TIFFANY ANN SMITH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1386813400
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY ANN SMITH
Provider Business Mailing Address
First Line : 9445 GA HIGHWAY 315
Second Line :
City : CATAULA
State : GA
Zip : 31804-2801
Country : US
Telephone Number : 706-341-5000
Fax Number :
Provider Business Practice Location Address
First Line : 1727 BOXWOOD PL
Second Line :
City : COLUMBUS
State : GA
Zip : 31906-2328
Country : US
Telephone Number : 706-569-0727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/22/2008
Last Update Date : 02/22/2008

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