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Individual

SWAYAMPRABHA S TYAGI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
414 LUGENIA DR, VIDALIA, GA 30474-7210
(912) 537-9355
(912) 537-7038
Mailing address
414 LUGENIA DR, VIDALIA, GA 30474-7210
(912) 537-9355
(912) 537-7038

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
32318
GA
208000000X
Pediatrics Physician
47063
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000517833B
GA
05
000517833F
GA
05
000517833H
GA
05
000517833I
GA
Enumeration date
01/26/2007
Last updated
11/15/2016
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