Individual
TYRONE SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMSW
Contact information
Practice address
1 FREEDOM WAY, AUGUSTA, GA 30904-6258
(706) 733-0188
Mailing address
1 FREEDOM WAY, AUGUSTA, GA 30904-6258
(803) 605-2506
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
12045
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12045
—
SC
Enumeration date
10/18/2018
Last updated
10/18/2018
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