Individual
HEATHER F TYRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
980 SOUTH 1ST STREET, JESUP, GA 31545
(912) 427-4267
(912) 559-2638
Mailing address
2400 BELLEVUE ROAD, SUITE 21-A, DUBLIN, GA 31021
(478) 275-7202
(478) 274-8418
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004357
GA
363AM0700X
Medical Physician Assistant
004357
GA
363AS0400X
Surgical Physician Assistant
004357
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
541791446
—
GA
Enumeration date
04/11/2006
Last updated
03/09/2022
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