Individual
TYNISHA WALTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
174 ANDERSON ST, TIGNALL, GA 30668-2739
(706) 401-5070
Mailing address
174 ANDERSON ST, TIGNALL, GA 30668-2739
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN087389
GA
Other
Enumeration date
10/31/2016
Last updated
10/31/2016
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