Active NPI
Tiffany Lyn Landrum
- Behavior Technician
- Villa Rica, GA
National Provider Identifier
1619506524
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 15-06617
- Practice address
- 3323 S McKoy Rd
Villa Rica, GA 30180-4107 - Phone
- (678) 777-4340
- NPI assigned
- Apr 2, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 15-06617 | GA | Primary |
Addresses
Primary practice location
3323 S McKoy Rd
Villa Rica, GA 30180-4107
Mailing address
3323 S McKoy Rd
Villa Rica, GA 30180-4107
Phone (678) 777-4340
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15-06617 | GA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1585785600000",
"number": "1619506524",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3323 S MCKOY RD",
"city": "VILLA RICA",
"state": "GA",
"postal_code": "301804107",
"telephone_number": "678-777-4340"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3323 S MCKOY RD",
"city": "VILLA RICA",
"state": "GA",
"postal_code": "301804107",
"telephone_number": "678-777-4340"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANDRUM",
"first_name": "TIFFANY",
"middle_name": "LYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-04-02",
"last_updated": "2020-04-02",
"certification_date": "2020-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "GA",
"license": "15-06617",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Villa Rica, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.