Individual
MR. DONALD GREGORY TISDALE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
10 CANEBRAKE BLVD STE 110-09, FLOWOOD, MS 39232-2211
(769) 333-8808
(769) 333-8809
Mailing address
10 CANEBRAKE BLVD STE 110-09, FLOWOOD, MS 39232-2211
(769) 333-8808
(769) 333-8809
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
902899
MS
Other
Enumeration date
09/12/2018
Last updated
05/26/2021
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