Provider Demographics
NPI:1588853055
Name:JAMES H TISON MD PC
Entity Type:Organization
Organization Name:JAMES H TISON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-374-5582
Mailing Address - Street 1:911 PLAZA AVE
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-6785
Mailing Address - Country:US
Mailing Address - Phone:478-374-5582
Mailing Address - Fax:478-374-3756
Practice Address - Street 1:911 PLAZA AVE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-6785
Practice Address - Country:US
Practice Address - Phone:478-374-5582
Practice Address - Fax:478-374-3756
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAMES H TISON MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015516207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP1545Medicare PIN