Individual provider · Type 1 NPI

Lychannel Ticole Head

Specialist · Mcdonough, GA

NPI number 1871163097 Active

Practice location

1631 Highway 20 W
Mcdonough, GA 30253-7311

Specialties and licenses

TaxonomyCodeLicense
Specialist Primary 174400000X1952405052 (GA)
Family Nurse Practitioner 363LF0000XF06211529 (GA)

Specialist: 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.

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About NPI 1871163097

Lychannel Ticole Head's National Provider Identifier is 1871163097, issued on Jun 29, 2021. The primary taxonomy on file is Specialist (174400000X), and the practice location is in Mcdonough, GA. The record was last updated on Jan 12, 2026.