Provider Demographics
NPI:1487333480
Name:CAWTHON, TIFFANY L (NP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:CAWTHON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 OLD MILL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30241-6704
Mailing Address - Country:US
Mailing Address - Phone:706-803-8500
Mailing Address - Fax:
Practice Address - Street 1:106 OLD MILL RD STE 100
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30241-6704
Practice Address - Country:US
Practice Address - Phone:706-803-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN238306363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily