Individual
MRS. TIFFANY M ROUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
63 PLEASANT HILL RD, BLAIRSVILLE, GA 30512-2291
(706) 745-2229
(706) 745-0836
Mailing address
PO BOX 2239, BLAIRSVILLE, GA 30514-2239
(706) 745-2229
(706) 745-0836
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
003539
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
907254555B
—
GA
Enumeration date
03/12/2008
Last updated
02/18/2010
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