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General NPI Number Information
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NPI Number | 1801781042
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Entity Type | Individual
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Provider Name | WILLIAM DAVIS TYUS FNP
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Gender | Male
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Dates
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Enumeration Date | 06/10/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 832 E SHOTWELL ST
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City | BAINBRIDGE
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State | GA
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Zip | 39819-4146
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Country | US
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Telephone | 229-234-6146
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Fax |
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Provider Business Mailing Address
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Address Line | 227 CHARLES COR
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City | MEXICO BEACH
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State | FL
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Zip | 32456-0201
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Country | US
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Telephone |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | GAA-NP003760
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | GAA-NP003760
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | APRN11041775
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License Number State | FL
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