Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | A4601 | NC |
NPI | 1003466582 |
---|---|
Provider Name | Tiffany Hairston |
First Address | Charlotte, NC 28212-6918 |
Second Address | Charlotte, NC 28212-6918 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2019 |
Last Update Date | 16/09/2019 |