Basic Information
| Provider Information | |||||||||
| NPI: | 1780178269 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TYSON | ||||||||
| FirstName: | ELISSA | ||||||||
| MiddleName: | HANDLEY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2152 OLD SPRINGVILLE RD | ||||||||
| Address2: | |||||||||
| City: | CENTER POINT | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352154005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058386000 | ||||||||
| FaxNumber: | 2058386078 | ||||||||
| Practice Location | |||||||||
| Address1: | 2152 OLD SPRINGVILLE RD | ||||||||
| Address2: | |||||||||
| City: | CENTER POINT | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352154005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058386000 | ||||||||
| FaxNumber: | 2058386078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2018 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD.38980 | AL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 1780178269 | AL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.