Healthcare Provider Details

I. General information

NPI: 1114303260
Provider Name (Legal Business Name): TENNIEL SINGLETON-THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 TROTTERS LN SE
CONYERS GA
30094-4189
US

IV. Provider business mailing address

PO BOX 83446
CONYERS GA
30013-9445
US

V. Phone/Fax

Practice location:
  • Phone: 678-661-1803
  • Fax:
Mailing address:
  • Phone: 404-838-6326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number058510994
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: