Provider Demographics
NPI:1780174698
Name:SINGLETON, WILLIAM HENRY (PTA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HENRY
Last Name:SINGLETON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 SPUTNIK ST
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-5120
Mailing Address - Country:US
Mailing Address - Phone:706-341-7438
Mailing Address - Fax:
Practice Address - Street 1:398 SPUTNIK ST
Practice Address - Street 2:
Practice Address - City:FORTSON
Practice Address - State:GA
Practice Address - Zip Code:31808-5120
Practice Address - Country:US
Practice Address - Phone:706-341-7438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant