Provider Demographics
NPI:1932973294
Name:TOLBERT, KIAH M
Entity Type:Individual
Prefix:
First Name:KIAH
Middle Name:M
Last Name:TOLBERT
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 1:2780 HALIGAN PT
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-1770
Mailing Address - Country:US
Mailing Address - Phone:404-903-8530
Mailing Address - Fax:
Practice Address - Street 1:2780 HALIGAN PT
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-1770
Practice Address - Country:US
Practice Address - Phone:404-903-8530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician