Avera, Tiffany Lachelle
Avera, Tiffany Lachelle is an sole proprietor health care provider with primary practice located at 80 Jesse Hill Jr Dr Se , Atlanta GA 30303-3031. She recently has only one registered license in Dietary & Nutritional Service Providers / Nutrition, Pediatric, which is considered as her primary health care specialty. Avera, Tiffany Lachelle can be contacted via phone (404) 616-6172.Contact Information
Primary practice address
80 Jesse Hill Jr Dr Se
Atlanta GA 30303-3031
Phone: (404) 616-6172
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dietary & Nutritional Service Providers / Nutrition, Pediatric | 133VN1004X | LD003667 | Georgia |
Profile Details
| NPI number | 1447592985 |
|---|---|
| LBN Legal business name | Avera, Tiffany Lachelle |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 22nd, 2013 |
| Last updated | Mar 22nd, 2013 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1447592985 | NPPES |
| Georgia | MEDICAID | 949089 |
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