Individual
MS. CHRISTINA DANIELS TYLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NPC
Contact information
Practice address
3755 SIXES RD, SUITE 100, CANTON, GA 30114
(770) 704-4580
(770) 704-9142
Mailing address
3755 SIXES RD, SUITE 100, CANTON, GA 30114-7842
(770) 704-4580
(770) 704-9142
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
RN153645NP
GA
363LF0000X
Family Nurse Practitioner
Primary
RN153645NP
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
153645
LIC NUMBER
GA
01
—
1952395097
NPI
GA
05
—
212738189A
—
GA
Enumeration date
11/15/2006
Last updated
07/01/2018
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