Provider Demographics
NPI:1699365247
Name:SINGLETON, TALISHAH NASTARSSIA
Entity Type:Individual
Prefix:
First Name:TALISHAH
Middle Name:NASTARSSIA
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 1:5656 JONESBORO RD
Mailing Address - Street 2:STE 111 # 215
Mailing Address - City:LAKE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30260
Mailing Address - Country:US
Mailing Address - Phone:404-883-7468
Mailing Address - Fax:
Practice Address - Street 1:823 VERDE DR
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-1647
Practice Address - Country:US
Practice Address - Phone:404-883-7468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health