Tiffiny Sequathia Grooms
Individual provider Active NPI Community/Behavioral Health Agency · Rex, GA
NPI 1376359554 · NPPES record last updated Dec 3, 2024
Key facts
- NPI
- 1376359554
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Practice address
- 6863 Red Maple Dr
Rex, GA 30273-2344 - Phone
- (770) 549-9323
- NPI assigned
- Dec 3, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Yes |
Addresses
Primary practice location
6863 Red Maple Dr
Rex, GA 30273-2344
Mailing address
6863 Red Maple Dr
Rex, GA 30273-2344
Phone (770) 549-9323
Other providers in Rex, GA
- Diangelo Godwin
- Myranda Grace
- Tiffany Gray
- Elizabeth Green
- Shajuanaka Grier
- Sharon Denise Harris-Stokes
- Juana Felipa Henriquez
- Samone Henry
- Hope & Grace, LLC
- Ychiva Hunter
All providers in Rex, GA · Community/Behavioral Health Agency in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.