Healthcare Provider Details

I. General information

NPI: 1114512530
Provider Name (Legal Business Name): MRS. TYRONA MURRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 02/12/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 PEACH ORCHARD RD STE 200
AUGUSTA GA
30906-2406
US

IV. Provider business mailing address

4010 OLD WAYNESBORO RD
AUGUSTA GA
30906-8125
US

V. Phone/Fax

Practice location:
  • Phone: 706-922-0600
  • Fax: 706-922-0603
Mailing address:
  • Phone: 706-288-8370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC014482
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: