Provider Demographics
NPI:1578038337
Name:MATHIS, BYRON TYRELL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BYRON
Middle Name:TYRELL
Last Name:MATHIS
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1021 SILVER BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-5879
Mailing Address - Country:US
Mailing Address - Phone:803-648-0587
Mailing Address - Fax:803-648-9846
Practice Address - Street 1:4720 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-5875
Practice Address - Country:US
Practice Address - Phone:706-650-0111
Practice Address - Fax:706-651-1882
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2022-01-25
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Provider Licenses
StateLicense IDTaxonomies
GA9011363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant