Provider Demographics
NPI:1033788807
Name:TENNYSON, TRAYVON
Entity Type:Individual
Prefix:MR
First Name:TRAYVON
Middle Name:
Last Name:TENNYSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 GREENLAND DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-5725
Mailing Address - Country:US
Mailing Address - Phone:470-526-0826
Mailing Address - Fax:
Practice Address - Street 1:166 GREENLAND DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-5725
Practice Address - Country:US
Practice Address - Phone:470-526-0826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician