Provider Demographics
NPI:1760370225
Name:GERMAIN, TYYOTALEE MICHELLE
Entity type:Individual
Prefix:
First Name:TYYOTALEE
Middle Name:MICHELLE
Last Name:GERMAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 NORTHSIDE DR APT B1
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2468
Mailing Address - Country:US
Mailing Address - Phone:904-578-4256
Mailing Address - Fax:
Practice Address - Street 1:3900 NORTHSIDE DR APT B1
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2468
Practice Address - Country:US
Practice Address - Phone:904-578-4256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor