Individual
TIFFANY RENEE RAINEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2151 W SPRING ST, MONROE, GA 30655-3115
(770) 267-1828
Mailing address
106 BROAD ST, LOGANVILLE, GA 30052-7463
(678) 635-8130
(678) 635-8131
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F0710420
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003105882A
—
GA
Enumeration date
08/31/2010
Last updated
03/15/2016
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