Active NPI
Tiffanie D Noonan, DO
- Pediatrics Physician
- Johns Island, SC
National Provider Identifier
1801830708
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 83446
- Practice address
- 3227 Walter Dr Ste C1
Johns Island, SC 29455-8171 - Phone
- (843) 920-0046
- Fax
- (843) 920-0001
- NPI assigned
- Jun 15, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | OS9813 | FL | |
| Pediatrics Physician | 208000000X | 83446 | SC | Primary |
Addresses
Primary practice location
3227 Walter Dr Ste C1
Johns Island, SC 29455-8171
Mailing address
PO Box 1661
Johns Island, SC 29457-1661
Phone (843) 920-0046
Other names 1
- Tiffanie D Mick
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA, SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS9813 | FL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vidalia Children'S Center LLC | Pediatrics | Current | Accepting new patients |
Locations
1702 Meadows Ln
Ste A
Vidalia, GA 30474
Phone (912) 537-9421
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pediatrics Physician
- Vidalia, GA
- NPI 1679705115
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626220800000",
"number": "1801830708",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1661",
"city": "JOHNS ISLAND",
"state": "SC",
"postal_code": "294571661",
"telephone_number": "843-920-0046",
"fax_number": "844-339-9220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3227 WALTER DR STE C1",
"city": "JOHNS ISLAND",
"state": "SC",
"postal_code": "294558171",
"telephone_number": "843-920-0046",
"fax_number": "843-920-0001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOONAN",
"first_name": "TIFFANIE",
"middle_name": "D",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-15",
"last_updated": "2021-07-14",
"certification_date": "2021-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "FL",
"license": "OS9813",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "SC",
"license": "83446",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "TIFFANIE",
"last_name": "MICK",
"middle_name": "D",
"credential": "DO",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Johns Island, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.