Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | AC5385578-R613 | NC |
N | 213EG0000X | General Practice | AC5385578-R613 | NC |
Y | 1223P0106X | Oral and Maxillofacial Pathology | 08976 | NC |
NPI | 1912225608 |
---|---|
Provider Name | Tiffany M Peters |
First Address | Greenville, NC 27834-5925 |
Second Address | Greenville, NC 27834-5925 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2010 |
Last Update Date | 29/10/2021 |