Provider Demographics
NPI:1801861562
Name:LYLES-ARNOLD, TAMMY ANITA (MD)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:ANITA
Last Name:LYLES-ARNOLD
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 1:420 E 2ND AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3210
Mailing Address - Country:US
Mailing Address - Phone:706-509-3000
Mailing Address - Fax:
Practice Address - Street 1:2370 ROCKMART HWY STE 100
Practice Address - Street 2:
Practice Address - City:CEDARTOWN
Practice Address - State:GA
Practice Address - Zip Code:30125-6029
Practice Address - Country:US
Practice Address - Phone:770-748-7818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA49308208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10052786OtherAMERIGROUP
GA358304OtherWELLCARE
GA625492081AMedicaid
260699313OtherTAX ID
GA625492081CMedicaid
GA625492081CMedicaid