Individual
TIFFANY BAGGETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1650 BARNES MILL RD APT 223, MARIETTA, GA 30062-7553
(678) 799-4191
Mailing address
1650 BARNES MILL RD APT 223, MARIETTA, GA 30062-7553
(678) 799-4191
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
—
GA
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
—
—
Other
Enumeration date
06/14/2018
Last updated
06/14/2018
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