Individual
ELIZABETH STREETT TYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
20 MEDICAL RIDGE DR, GREENVILLE, SC 29605-4267
(864) 220-7270
(864) 241-9211
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
30313
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
303139
—
SC
01
—
576007863102
BCBS
SC
Enumeration date
11/03/2006
Last updated
06/15/2021
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