Provider Demographics
NPI:1659041267
Name:TYER-MBAYE, SABRINA (RN)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:TYER-MBAYE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 ANDERSON AVE NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30314-1835
Mailing Address - Country:US
Mailing Address - Phone:470-794-2477
Mailing Address - Fax:
Practice Address - Street 1:3909 CAMPBELLTON RD SW APT G4
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5021
Practice Address - Country:US
Practice Address - Phone:470-430-0076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN241800163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0000000000Medicaid
GA0000000000OtherNON MEDICAID
GA049233169OtherDEPT OF DRIVER SERVICES
NY0000000000Medicaid