Individual
TIFFANY MCKINNIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
1000 MEDICAL CENTER BLVD, LAWRENCEVILLE, GA 30046-7694
(678) 312-4416
Mailing address
1000 MEDICAL CENTER BLVD, LAWRENCEVILLE, GA 30046-7694
(678) 312-4416
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
054623
GA
208000000X
Pediatrics Physician
54623
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164512785C
—
GA
Enumeration date
09/22/2006
Last updated
09/06/2013
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