Healthcare Provider Details

I. General information

NPI: 1295649960
Provider Name (Legal Business Name): TYLER ELIZABETH HEAD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 N LEE ST
FORSYTH GA
31029-2122
US

IV. Provider business mailing address

130 N LEE ST
FORSYTH GA
31029-2122
US

V. Phone/Fax

Practice location:
  • Phone: 478-974-6080
  • Fax: 478-974-9002
Mailing address:
  • Phone: 478-974-6080
  • Fax: 478-974-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP312547
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: