Provider Demographics
NPI:1548941578
Name:TOMBERLIN, TONI MILES
Entity type:Individual
Prefix:
First Name:TONI
Middle Name:MILES
Last Name:TOMBERLIN
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:PO BOX 477
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31515-0477
Mailing Address - Country:US
Mailing Address - Phone:912-278-0494
Mailing Address - Fax:
Practice Address - Street 1:597 MAX DEEN DR
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-8235
Practice Address - Country:US
Practice Address - Phone:912-278-0494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical