Individual provider Active NPI

James W Tyson VI, MD

  • Emergency Medicine Physician
  • Marietta, GA
National Provider Identifier
1114668415
Registry record updated Aug 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
103952 Issued in GA
Practice address
677 Church St NE
Marietta, GA 30060-1101
Phone
(770) 793-5000
NPI assigned
Apr 2, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Emergency Medicine Physician 207P00000X 103952 GA Primary

Addresses

Primary practice location

677 Church St NE
Marietta, GA 30060-1101

Mailing address

677 Church St NE
Marietta, GA 30060-1101

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250923004543 GA Practitioner - Emergency Medicine 4688054406 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Acs Primary Care Physicians - Southeast PCGroup PAC ID 5193620714, 409 clinicians

Practice addresses (Care Compare)

2151 W Spring St
Monroe, GA 30655-3202
Phone (770) 267-8461

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
103952GAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Acs Primary Care Physicians - Southeast PC Emergency Medicine CurrentSince Aug 15, 2025 Accepting new patients

Locations

2151 W Spring St
Monroe, GA 30655
Phone (770) 267-1792

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1648857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756512000000",
    "number": "1114668415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "677 CHURCH ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "677 CHURCH ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601101",
            "telephone_number": "770-793-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYSON",
        "first_name": "JAMES",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "name_suffix": "VI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-02",
        "last_updated": "2025-08-30",
        "certification_date": "2025-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "103952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

Verify at the official NPI Registry.