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Lychannel Ticole Head
Specialist in Locust Grove, Georgia
NPI 1871163097

Lychannel Ticole Head is a Specialist based in Locust Grove, GA. Lychannel Ticole Head practices in Locust Grove, GA. The NPI Number for Lychannel Ticole Head is 1871163097 and holds a License No. F06211529 (Georgia).

The current practice location address for Lychannel Ticole Head is 4865 Bill Gardner Pkwy, Locust Grove, GA and can be reached out via phone at 770-692-0100.

Location: 4865 Bill Gardner Pkwy, Locust Grove, GA, 30248-3644
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1871163097
Provider Name
Lychannel Ticole Head
Credential
Provider Entity Type
Individual
Gender
Female
Address
4865 Bill Gardner Pkwy, Locust Grove, GA, 30248-3644
Phone Number
770-692-0100
Fax Number
Provider Enumeration Date
06/29/2021
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
4865 Bill Gardner Pkwy
City
Locust Grove
State
Georgia
Zip
30248-3644
Phone Number
770-692-0100
Fax Number
person
Provider Business Mailing Address Details
Address
4865 Bill Gardner Pkwy
City
Locust Grove
State
Georgia
Zip
30248-3644
Phone Number
770-692-0100
Fax Number
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
1952405052 (Georgia)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
person
Provider's Taxonomy Details 2
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
363LF0000X
License No.
F06211529 (Georgia)
Definition
Definition to come...
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