Individual
MARY LYNN TYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1727 WRIGHTSBORO RD, SUITE B, AUGUSTA, GA 30904-4074
(706) 736-8170
(706) 736-8184
Mailing address
1727 WRIGHTSBORO RD, SUITE B, AUGUSTA, GA 30904-4074
(706) 736-8170
(706) 736-8184
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
030683
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000606317B
—
GA
05
—
000902063V
—
GA
Enumeration date
12/07/2005
Last updated
10/21/2013
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