MEDICARE: TIFFANY BOGUS

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
1	104100000X	Social Worker	3089G	AL

General Provider Information

NPI Number	:	1902722572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY BOGUS

Provider Business Mailing Address
First Line	:	2114 COLONY PARK DR
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-2371
Country	:	US
Telephone Number	:	205-541-8589
Fax Number	:

Provider Business Practice Location Address
First Line	:	1687 CENTER POINT PKWY
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35215-5528
Country	:	US
Telephone Number	:	205-557-7022
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2026
Last Update Date	:	06/26/2026

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Directions to “ TIFFANY BOGUS ” Practice Location

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