Provider Demographics
NPI:1396393120
Name:MUHAMMAD, TINA YVETTE
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:YVETTE
Last Name:MUHAMMAD
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 1:1073 LANIER SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-7234
Mailing Address - Country:US
Mailing Address - Phone:678-755-8725
Mailing Address - Fax:
Practice Address - Street 1:1073 LANIER SPRINGS DR
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-7234
Practice Address - Country:US
Practice Address - Phone:678-755-8725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHCP010435251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health