Individual
MRS. STEPHANIE E. TYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
134 MOUNTAINSIDE VILLAGE PKWY STE 100, JASPER, GA 30143-8694
(706) 253-3100
(706) 253-3101
Mailing address
1835 SAVOY DR STE 300, ATLANTA, GA 30341-1071
(706) 253-3100
(706) 253-3101
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN200512
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003203586A
—
GA
01
—
G04354A
MEDICARE PTAN
GA
Enumeration date
04/18/2017
Last updated
09/01/2020
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