Provider Demographics
NPI:1356560536
Name:SILLS, TINA (DC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:SILLS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 ELDERBERRY TRL
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7823
Mailing Address - Country:US
Mailing Address - Phone:770-461-8733
Mailing Address - Fax:
Practice Address - Street 1:5640 OLD NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-3834
Practice Address - Country:US
Practice Address - Phone:404-768-8008
Practice Address - Fax:404-768-9303
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCHXKMedicare ID - Type Unspecified
GAV02750Medicare UPIN