Provider Demographics
NPI:1003830696
Name:TYE, GEORGIA K (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGIA
Middle Name:K
Last Name:TYE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:109 CHALFORD PLACE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087
Mailing Address - Country:US
Mailing Address - Phone:615-453-7555
Mailing Address - Fax:727-507-3618
Practice Address - Street 1:726 MCFARLAND ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-3989
Practice Address - Country:US
Practice Address - Phone:423-522-6560
Practice Address - Fax:423-587-4552
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD22195207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C67523Medicare UPIN