Provider Demographics
NPI:1174920615
Name:CLAYTON, TYGER CYERRA NAOMI MEADE (PA-C)
Entity type:Individual
Prefix:
First Name:TYGER
Middle Name:CYERRA NAOMI MEADE
Last Name:CLAYTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TYGER
Other - Middle Name:CYERRA
Other - Last Name:CLAYTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:108 MASSEY ST
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-2009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:109 MINIS AVE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:GA
Practice Address - Zip Code:31408-2128
Practice Address - Country:US
Practice Address - Phone:912-966-5445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7397363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant