Provider Demographics
NPI:1366760001
Name:PETTY, TIFFANY JONES (MD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:JONES
Last Name:PETTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 DOCTORS DRIVE
Mailing Address - Street 2:SANFORD PEDIATRICS, P.A.
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-5067
Mailing Address - Country:US
Mailing Address - Phone:919-774-7117
Mailing Address - Fax:919-776-6715
Practice Address - Street 1:1801 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-5067
Practice Address - Country:US
Practice Address - Phone:919-774-7117
Practice Address - Fax:919-776-6715
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL32629208000000X
390200000X
NC2017-01510208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program