Individual
TIFFANY LACHELLE AVERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
80 JESSE HILL JR DR SE, ATLANTA, GA 30303-3031
(404) 616-6172
Mailing address
2724 PANGBORN RD, DECATUR, GA 30033-2326
Taxonomy
Speciality
Code
Description
License number
State
133VN1004X
Pediatric Nutrition Registered Dietitian
Primary
LD003667
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
949089
—
GA
Enumeration date
03/22/2013
Last updated
03/22/2013
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