Basic Information
Provider Information
NPI: 1003007055
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOWARD
FirstName: TIFFANY
MiddleName: NICOLE
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 103 SUM MOR DR
Address2: VITALITY MEDICAL CENTERS, INC.
City: WEST COLUMBIA
State: SC
PostalCode: 291694828
CountryCode: US
TelephoneNumber: 8032189886
FaxNumber:  
Practice Location
Address1: 103 SUM MOR DR
Address2: VITALITY MEDICAL CENTERS, INC.
City: WEST COLUMBIA
State: SC
PostalCode: 291694828
CountryCode: US
TelephoneNumber: 8032189886
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/06/2007
LastUpdateDate: 06/07/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208100000X36775SCY Allopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation 
208100000X0101241315VAN Allopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation 

No ID Information.


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