Organization Name: | RODNEY D. TYSON MD,PC |
NPI Number: | 1245419183 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RODNEY DONALD TYSON (PRESIDENT) |
Mailing Address: | 103 James St Adel |
State: | GA US |
Postal Code: | 316201504 |
Phone Number: | 2298963424 |
Fax Number: | 2298963838 |
NPI Enumeration Date: | 10/28/2007 |
NPI Last Update Date: | 01/04/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 038994 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |