Individual
TIFFANY LL WORTHINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
805 HALL ST, WIGGINS, MS 39577-2110
(601) 928-4412
(601) 928-4792
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 928-4412
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21273
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07133522
—
MS
05
—
2976874
—
OH
01
—
6041723
HEALTHSPRING
MS
01
—
9988338
AETNA
MS
01
—
P00739243
RR MEDICARE
OH
01
—
P00933673
RAILROAD MEDICARE
MS
Enumeration date
11/15/2006
Last updated
02/28/2017
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