Individual
JENNIFER L TYSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2701 N DECATUR RD, DECATUR, GA 30033-5918
(404) 501-1000
Mailing address
190 GRINDLE BRIDGE RD, DAHLONEGA, GA 30533-3552
(706) 974-3459
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
009029
GA
Other
Enumeration date
08/31/2018
Last updated
10/08/2018
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