Individual
DANIELLE TYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6060 LAKESIDE COMMONS DR, MACON, GA 31210-5778
(478) 745-9204
Mailing address
6060 LAKESIDE COMMONS DR, MACON, GA 31210-5778
(478) 745-9204
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
280985
GA
Other
Enumeration date
08/28/2023
Last updated
06/19/2024
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