1083994974 NPI number — MRS. CAROLYN YVONNE SINGLETON-RUSSELL CSFA/BSHA/HM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083994974 NPI number — MRS. CAROLYN YVONNE SINGLETON-RUSSELL CSFA/BSHA/HM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SINGLETON-RUSSELL
Provider First Name:
CAROLYN
Provider Middle Name:
YVONNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CSFA/BSHA/HM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SINGLETON-GRANT
Provider Other First Name:
CAROLYN
Provider Other Middle Name:
YVONNE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CSFA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083994974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 172
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUWANEE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-787-5912
Provider Business Mailing Address Fax Number:
770-985-4258

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1514 EAST CLEVELAND AVENUE
Provider Second Line Business Practice Location Address:
SUITE 117
Provider Business Practice Location Address City Name:
EAST POINT
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-715-4651
Provider Business Practice Location Address Fax Number:
770-985-4258
Provider Enumeration Date:
08/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  111678 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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