Provider Demographics
NPI:1245945070
Name:SMART, TIFFANY REGINA (DC)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:REGINA
Last Name:SMART
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 PEACHTREE PKWY STE 270
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1050
Mailing Address - Country:US
Mailing Address - Phone:678-541-9100
Mailing Address - Fax:
Practice Address - Street 1:2615 PEACHTREE PKWY STE 270
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1050
Practice Address - Country:US
Practice Address - Phone:678-541-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010903111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor