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NPI Code Detail

MEDICARE: RYAN HENRY TIE-SHUE

MEDICARE:   RYAN HENRY TIE-SHUE
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1932047818
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN HENRY TIE-SHUE
Provider Business Mailing Address
First Line : 49 JESSE HILL JR DR SE
Second Line :
City : ATLANTA
State : GA
Zip : 30303-3049
Country : US
Telephone Number : 404-778-7777
Fax Number :
Provider Business Practice Location Address
First Line : 49 JESSE HILL JR DR SE
Second Line :
City : ATLANTA
State : GA
Zip : 30303-3049
Country : US
Telephone Number : 404-778-7777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2026
Last Update Date : 03/23/2026

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Directions to “ RYAN HENRY TIE-SHUE ” Practice Location

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