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General NPI Number Information
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NPI Number | 1609048024
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Entity Type | Individual
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Provider Name | TIA ALYNN GEORGE
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Gender | Female
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Dates
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Enumeration Date | 03/26/2008
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 1218 ALICE ST
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City | WAYCROSS
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State | GA
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Zip | 31501-4525
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Country | US
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Telephone | 912-284-9800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 294 501 OLD PEARSON RD
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City | HOMERVILLE
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State | GA
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Zip | 31634-0294
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Country | US
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Telephone | 229-630-4073
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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