Provider Demographics
NPI:1619387461
Name:SINGLETON, TYSHEMALA
Entity Type:Individual
Prefix:
First Name:TYSHEMALA
Middle Name:
Last Name:SINGLETON
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 1:5122 SUMMERSUN DR
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-3779
Mailing Address - Country:US
Mailing Address - Phone:404-798-8455
Mailing Address - Fax:404-366-2972
Practice Address - Street 1:5122 SUMMERSUN DR
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-3779
Practice Address - Country:US
Practice Address - Phone:404-798-8455
Practice Address - Fax:404-366-2972
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health