MEDICARE: TIFFANY NICOLE TURNER D.O.

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	208000000X	Pediatrics Physician	93053	GA
2	390200000X	Student in an Organized Health Care Education/Training Program		LA

General Provider Information

NPI Number	:	1992202568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY NICOLE TURNER D.O.

Provider Business Mailing Address
First Line	:	1409 CHATTANOOGA AVE
Second Line	:
City	:	DALTON
State	:	GA
Zip	:	30720-2631
Country	:	US
Telephone Number	:	706-278-5373
Fax Number	:

Provider Business Practice Location Address
First Line	:	PEDIATRICS OF DALTON
Second Line	:	1409 CHATTANOOGA AVE EXT
City	:	DALTON
State	:	GA
Zip	:	30720
Country	:	US
Telephone Number	:	706-278-5373
Fax Number	:

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

Provider Enumeration Date	:	04/10/2018
Last Update Date	:	03/08/2026

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