Healthcare Provider Details

I. General information

NPI: 1083994974
Provider Name (Legal Business Name): CAROLYN YVONNE SINGLETON-RUSSELL CSFA/BSHA/HM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAROLYN YVONNE SINGLETON-GRANT CSFA

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 EAST CLEVELAND AVENUE SUITE 117
EAST POINT GA
30344
US

IV. Provider business mailing address

P.O. BOX 172
SUWANEE GA
30024
US

V. Phone/Fax

Practice location:
  • Phone: 770-715-4651
  • Fax: 770-985-4258
Mailing address:
  • Phone: 678-787-5912
  • Fax: 770-985-4258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number111678
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: