Individual
TIFFANY KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2770 EB HAMILTON DR APT 203, TIFTON, GA 31793-5060
(229) 472-2691
Mailing address
2770 EB HAMILTON DR APT 203, TIFTON, GA 31793-5060
(229) 472-2691
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
051559217
GA
Other
Enumeration date
05/08/2019
Last updated
05/08/2019
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