Provider Demographics
NPI:1366274466
Name:TOMLINSON, CASEY
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:TOMLINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 HARTLEY DR
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-9403
Mailing Address - Country:US
Mailing Address - Phone:702-306-6990
Mailing Address - Fax:
Practice Address - Street 1:326 MYRTLE CROSSING DR STE 200
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4689
Practice Address - Country:US
Practice Address - Phone:912-489-7590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC009777101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional