Provider Demographics
NPI:1871666404
Name:TYLER, CHRISTINA DANIELS (NPC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:DANIELS
Last Name:TYLER
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:MRS
Other - First Name:CHRISTINA
Other - Middle Name:DANIELS
Other - Last Name:TYLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:3755 SIXES RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-7842
Mailing Address - Country:US
Mailing Address - Phone:770-704-4580
Mailing Address - Fax:770-704-9142
Practice Address - Street 1:3755 SIXES RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114
Practice Address - Country:US
Practice Address - Phone:770-704-4580
Practice Address - Fax:770-704-9142
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2018-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN153645NP207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA212738189AMedicaid
GA153645OtherLIC NUMBER
GA1952395097OtherNPI
GA58-1896463OtherSOUTHERN HEALTH CORP OF ELLIJAY