Provider Demographics
NPI:1780120014
Name:SILLS, TONIE
Entity type:Individual
Prefix:
First Name:TONIE
Middle Name:
Last Name:SILLS
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 1:4206 OLD LINCOLNTON RD
Mailing Address - Street 2:
Mailing Address - City:APPLING
Mailing Address - State:GA
Mailing Address - Zip Code:30802-4108
Mailing Address - Country:US
Mailing Address - Phone:706-962-1752
Mailing Address - Fax:706-760-0551
Practice Address - Street 1:4206 OLD LINCOLNTON RD
Practice Address - Street 2:
Practice Address - City:APPLING
Practice Address - State:GA
Practice Address - Zip Code:30802-4108
Practice Address - Country:US
Practice Address - Phone:706-962-1752
Practice Address - Fax:706-760-0551
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA747544484CMedicaid