Individual
MISS TIFFANI L GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LD
Contact information
Practice address
2500 NORTH STATE STREET, DEPARTMENT OF MEDICINE/DIVISION OF GENERAL INTERNAL MED, JACKSON, MS 39216-4500
(601) 984-5660
Mailing address
P.O. BOX 24146, UNIVERSITY PHYSICIANS, PLLC, JACKSON, MS 39225-4146
(601) 984-5660
(601) 984-6870
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
D1248
MS
Other
Enumeration date
10/01/2007
Last updated
06/23/2009
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