MEDICARE: CHRISTINA TYREE GARY FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN197577	GA

General Provider Information

NPI Number	:	1750951349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA TYREE GARY FNP

Provider Business Mailing Address
First Line	:	1745 OLD SPRING HOUSE LN
Second Line	:
City	:	DUNWOODY
State	:	GA
Zip	:	30338-6216
Country	:	US
Telephone Number	:	706-814-8871
Fax Number	:

Provider Business Practice Location Address
First Line	:	1745 OLD SPRING HOUSE LN
Second Line	:
City	:	DUNWOODY
State	:	GA
Zip	:	30338-6216
Country	:	US
Telephone Number	:	706-814-8871
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2021
Last Update Date	:	06/28/2021

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