Provider Demographics
NPI:1245988583
Name:TYREE, MATTHEW ANTHONY (NP)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ANTHONY
Last Name:TYREE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 BEAR CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:GA
Mailing Address - Zip Code:30055-3311
Mailing Address - Country:US
Mailing Address - Phone:678-449-9418
Mailing Address - Fax:
Practice Address - Street 1:777 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2102
Practice Address - Country:US
Practice Address - Phone:478-633-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN235503363LF0000X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services