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

Table of content: MR. ROBERT REGINALD MEADE ATC (NPI 1063459618)

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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