Individual
SHAWN E TYWON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
420 NORTHSIDE DR, VALDOSTA, GA 31602
(229) 375-2522
(229) 329-4140
Mailing address
420 NORTHSIDE DR, VALDOSTA, GA 31602-1802
(229) 375-2522
(229) 329-4140
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2613
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100001467A
—
GA
05
—
290780100
—
FL
Enumeration date
03/10/2006
Last updated
05/18/2018
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