Individual
AMANDA FAYE TISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, FNP-C
Contact information
Practice address
4837 BILL GARDNER PKWY STE B, LOCUST GROVE, GA 30248-3734
(678) 800-1602
Mailing address
72 BOLINGVIEW RD, JULIETTE, GA 31046-3932
(904) 507-1221
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
11002465
FL
363LF0000X
Family Nurse Practitioner
Primary
GAA-NP000337
GA
Other
Enumeration date
05/16/2019
Last updated
12/02/2021
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