Provider Demographics
NPI:1033532825
Name:TYSON, NADIA ABOUSSOUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NADIA
Middle Name:ABOUSSOUAN
Last Name:TYSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 N LIVINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-5034
Mailing Address - Country:US
Mailing Address - Phone:601-856-8301
Mailing Address - Fax:
Practice Address - Street 1:675 N LIVINGSTON RD
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5034
Practice Address - Country:US
Practice Address - Phone:601-856-8301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS046052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology