Basic Information
| Provider Information | |||||||||
| NPI: | 1578811667 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GARRISON-JETER | ||||||||
| FirstName: | TIFFANIE | ||||||||
| MiddleName: | LASHAUN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6998 OLD CUSSETA RD | ||||||||
| Address2: | |||||||||
| City: | FORT BENNING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319055431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065443176 | ||||||||
| FaxNumber: | 7065441933 | ||||||||
| Practice Location | |||||||||
| Address1: | 6998 OLD CUSSETA RD | ||||||||
| Address2: | |||||||||
| City: | FORT BENNING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319055431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7065443176 | ||||||||
| FaxNumber: | 7065441933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2012 | ||||||||
| LastUpdateDate: | 05/24/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 9488 | TN | Y | Dental Providers | Dentist | 1223G0001X | 9488 | TN | N | Dental Providers | Dentist | General Practice |
No ID Information.