Provider Demographics
NPI:1114303260
Name:SINGLETON-THOMAS, TENNIEL
Entity Type:Individual
Prefix:
First Name:TENNIEL
Middle Name:
Last Name:SINGLETON-THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 83446
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-9445
Mailing Address - Country:US
Mailing Address - Phone:404-838-6326
Mailing Address - Fax:
Practice Address - Street 1:533 TROTTERS LN SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-4189
Practice Address - Country:US
Practice Address - Phone:678-661-1803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171M00000X, 171W00000X
GA058510994172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171W00000XOther Service ProvidersContractor