Rodney D. Tyson MD,PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

038994 Issued in GA

Legal business name

RODNEY D. TYSON MD,PC

Practice address

103 James St
Adel, GA 31620-1504

Phone

(229) 896-3424

Fax

(229) 896-3838

NPI assigned

Oct 28, 2007

Last updated

Jan 4, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Rodney Donald Tyson Sr., M.D.

Title

President

Phone

(229) 896-3424

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1193529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262563200000",
    "number": "1245419183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 JAMES ST",
            "city": "ADEL",
            "state": "GA",
            "postal_code": "316201504",
            "telephone_number": "229-896-3424",
            "fax_number": "229-896-3838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 JAMES ST",
            "city": "ADEL",
            "state": "GA",
            "postal_code": "316201504",
            "telephone_number": "229-896-3424",
            "fax_number": "229-896-3838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RODNEY D. TYSON MD,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-28",
        "last_updated": "2010-01-04",
        "status": "A",
        "authorized_official_last_name": "TYSON",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_middle_name": "DONALD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "229-896-3424",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "GA",
            "license": "038994",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "507222",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00703425A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristy Fletcher Penuel, MOT, BS, BBM, COTA/L
• Sala Pressley, RPH
• Daniel Blake Purvis, PHARM D
• Grace Lisette Rivera, LDO
• Melissa Michelle Roberts, FNP-C
• Buie Jeffery Rowan, PHARMD
• Lora Emily Schramm, PHARM.D.
• Tim Markam Sellers, O.D.
• Senior Citizens Choice, LLC
• Monica Smith

• Primary Care Clinic/Center in Adel, GA
• Providers in Adel, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.