Provider Demographics
NPI:1083994974
Name:SINGLETON-RUSSELL, CAROLYN YVONNE (CSFA/BSHA/HM)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:YVONNE
Last Name:SINGLETON-RUSSELL
Suffix:
Gender:F
Credentials:CSFA/BSHA/HM
Other - Prefix:MRS
Other - First Name:CAROLYN
Other - Middle Name:YVONNE
Other - Last Name:SINGLETON-GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSFA
Mailing Address - Street 1:P.O. BOX 172
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024
Mailing Address - Country:US
Mailing Address - Phone:678-787-5912
Mailing Address - Fax:770-985-4258
Practice Address - Street 1:1514 EAST CLEVELAND AVENUE
Practice Address - Street 2:SUITE 117
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344
Practice Address - Country:US
Practice Address - Phone:770-715-4651
Practice Address - Fax:770-985-4258
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA111678208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery