Provider Demographics
NPI:1386259570
Name:BIRMINGHAM, TUSONAH ANN (RPSGT)
Entity type:Individual
Prefix:MS
First Name:TUSONAH
Middle Name:ANN
Last Name:BIRMINGHAM
Suffix:
Gender:F
Credentials:RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7297 WALTON HL
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-7110
Mailing Address - Country:US
Mailing Address - Phone:888-912-4486
Mailing Address - Fax:404-393-9913
Practice Address - Street 1:7297 WALTON HL
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-7110
Practice Address - Country:US
Practice Address - Phone:888-912-4486
Practice Address - Fax:404-393-9913
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA22134261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic