Individual
JAMES HARMON TISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1085 PLAZA AVE STE B, EASTMAN, GA 31023-9102
(478) 374-5582
(478) 374-3756
Mailing address
1085 PLAZA AVE, EASTMAN, GA 31023-9102
(478) 559-1386
(478) 559-1388
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
015516
GA
208D00000X
General Practice Physician
Primary
015516
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000091011A
—
GA
01
—
407111537
RR MCARE
—
01
—
52044058
BCBS
—
Enumeration date
11/21/2006
Last updated
08/08/2017
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