Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD22195 | TN |
NPI | 1003830696 |
---|---|
Provider Name | Dr. Georgia K Tye |
First Address | Lebanon, TN 37087 |
Second Address | Morristown, TN 37814-3989 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 11/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C67523 | (02) |