Provider Demographics
NPI:1316729445
Name:TOLSON, BARBARA SAMANTHA GREEN
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:SAMANTHA GREEN
Last Name:TOLSON
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 1:3177 E BAGGETT RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30187-1598
Mailing Address - Country:US
Mailing Address - Phone:404-661-1240
Mailing Address - Fax:
Practice Address - Street 1:3136 GOLF RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1952
Practice Address - Country:US
Practice Address - Phone:877-288-4760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician