Individual
MRS. TIFFANY MARCELO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6350 REIVES RD, CUMMING, GA 30041-9210
(770) 241-8461
Mailing address
6350 REIVES RD, CUMMING, GA 30041-9210
(770) 241-8461
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
SC19013
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SC19013
SERVICE COORDINATOR CERTIFICATE
GA
Enumeration date
06/27/2019
Last updated
06/27/2019
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