Provider Demographics
NPI:1174598585
Name:CARROLL, TIFFENY S (MD)
Entity type:Individual
Prefix:DR
First Name:TIFFENY
Middle Name:S
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2727 PACES FERRY RD SE STE 1-1100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6151
Mailing Address - Country:US
Mailing Address - Phone:770-400-4523
Mailing Address - Fax:678-423-2737
Practice Address - Street 1:775 POPLAR RD STE 120
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-8301
Practice Address - Country:US
Practice Address - Phone:770-400-4523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA081559207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0701458OtherUNITED HEALTHCARE NUMBER
NCP00429771OtherRAIL ROAD MEDICARE
NC89137POMedicaid
NCD5660OtherMEDCOST NUMBER
NC6889325OtherCIGNA NUMBER
NC7949588OtherAETNA NUMBER
NC7396073OtherMAMSI NUMBER
NC137POOtherBCBS NUMBER
NC804763OtherPARTNERS MEDICARE CHOICE
NC804763OtherPARTNERS MEDICARE CHOICE