Provider Demographics
NPI:1053989962
Name:HAIRSTON, TIFFANY SIMMS (RN)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:SIMMS
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1451 VALLEY TRAIL WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-3658
Mailing Address - Country:US
Mailing Address - Phone:404-358-0717
Mailing Address - Fax:678-736-8096
Practice Address - Street 1:1451 VALLEY TRAIL WAY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-3658
Practice Address - Country:US
Practice Address - Phone:404-358-0717
Practice Address - Fax:678-736-8096
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN228251163WC1500X
GARN22820163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health