Provider Demographics
NPI:1043316052
Name:BYRD, TIFFANY T (MD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:T
Last Name:BYRD
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:TIFFANY
Other - Middle Name:T
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6600 VAN AALST BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT BENNING
Mailing Address - State:GA
Mailing Address - Zip Code:31905-2102
Mailing Address - Country:US
Mailing Address - Phone:706-544-5913
Mailing Address - Fax:762-408-8154
Practice Address - Street 1:6600 VAN AALST BLVD
Practice Address - Street 2:
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-2102
Practice Address - Country:US
Practice Address - Phone:706-544-5913
Practice Address - Fax:762-408-8154
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA56623207Q00000X
GA056623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAVAD00Medicare UPIN