Provider Demographics
NPI:1740322635
Name:TINAWANE FAMILY SERVICES
Entity type:Organization
Organization Name:TINAWANE FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RETINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON-YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:404-428-8038
Mailing Address - Street 1:5090 ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-1140
Mailing Address - Country:US
Mailing Address - Phone:404-428-8038
Mailing Address - Fax:
Practice Address - Street 1:5090 ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-1140
Practice Address - Country:US
Practice Address - Phone:404-428-8038
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10052853OtherAMERIGROUP
GA414894283AMedicaid
GA833749000OtherMAGELLAN