Healthcare Provider Details

I. General information

NPI: 1750181889
Provider Name (Legal Business Name): CHANCE STEWART TINER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 S 1ST ST
JESUP GA
31545-0210
US

IV. Provider business mailing address

2570 GA HIGHWAY 32 E
MERSHON GA
31551-2054
US

V. Phone/Fax

Practice location:
  • Phone: 912-816-3230
  • Fax:
Mailing address:
  • Phone: 912-281-9148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN294402
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN294402
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: