Individual
TIFFANI YVONNE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
121 AURORA PL STE B, AIKEN, SC 29801-5312
(803) 306-7733
(803) 716-9456
Mailing address
367 S GULPH RD, ATTN IPM CREDENTIALING, KING OF PRUSSIA, PA 19406-3121
(803) 306-7733
(803) 716-9456
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
85674
SC
207Q00000X
Family Medicine Physician
MD36325
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
856746
—
SC
Enumeration date
05/23/2016
Last updated
09/17/2021
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