LYCHANNEL TICOLE HEAD NPI 1871163097

NPI Information

  • NPI: 1871163097
  • Provider Name: LYCHANNEL TICOLE HEAD
  • Classification: Specialist - 174400000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 4865 BILL GARDNER PKWY
    LOCUST GROVE, GA
    ZIP 30248
  • Phone: (770) 692-0100

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NPI Details

Lychannel Ticole Head is a specialist in Locust Grove, GA with 4 years of experience. The provider is 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. Lychannel Ticole Head NPI is 1871163097. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

4865 BILL GARDNER PKWY
LOCUST GROVE, GA
ZIP 30248-644
Phone: (770) 692-0100

The NPI 1871163097 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/29/2021 and was last updated on 1/20/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamilyF06211529GEORGIANo
2174400000XSpecialist1952405052GEORGIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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