Provider Demographics
NPI:1629761333
Name:TYSON, CHRISTY (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:TYSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 S HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-8941
Mailing Address - Country:US
Mailing Address - Phone:770-214-7310
Mailing Address - Fax:770-214-7410
Practice Address - Street 1:1735 S HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-8941
Practice Address - Country:US
Practice Address - Phone:770-214-7310
Practice Address - Fax:770-214-7410
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2310156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician