Provider Demographics
NPI:1639974207
Name:GRIFFITH-BULLARD, TONYA MICHELLE
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:MICHELLE
Last Name:GRIFFITH-BULLARD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:MICHELLE
Other - Last Name:GRIFFITH-MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5102
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44101-0102
Mailing Address - Country:US
Mailing Address - Phone:216-600-6245
Mailing Address - Fax:
Practice Address - Street 1:7305 CARSON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-4127
Practice Address - Country:US
Practice Address - Phone:216-600-6245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist