Provider Demographics
NPI:1366404857
Name:TINLEY, SANDRA E (MD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:E
Last Name:TINLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N RIDGEWAY DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-5118
Mailing Address - Country:US
Mailing Address - Phone:817-641-2600
Mailing Address - Fax:
Practice Address - Street 1:505 N RIDGEWAY DR
Practice Address - Street 2:SUITE 160
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-5118
Practice Address - Country:US
Practice Address - Phone:817-641-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA21603173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00286888AMedicaid
GA00286888AMedicaid