Individual
DR. RODNEY D TYSON SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
901 18TH ST E, TIFTON, GA 31794-3648
(229) 382-7120
Mailing address
907 18TH ST E, SUITE 150, TIFTON, GA 31794-3643
(229) 353-3422
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
038994
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00703425A
—
GA
01
—
507222
BCBS PROVIDER NUMBER
GA
01
—
58-2255001
TAX ID
GA
Enumeration date
10/04/2006
Last updated
12/01/2020
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