MEDICARE: MR. GARY TYLER NEFF RBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156F00000X	Technician/Technologist	RBT-19-98556	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RBT-19-98556	OTHER		BACB

General Provider Information

NPI Number	:	1093366940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY TYLER NEFF RBT

Provider Business Mailing Address
First Line	:	3655 HOWELL FERRY RD
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-3186
Country	:	US
Telephone Number	:	770-373-5822
Fax Number	:

Provider Business Practice Location Address
First Line	:	3655 HOWELL FERRY RD
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-3186
Country	:	US
Telephone Number	:	770-373-5822
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2019
Last Update Date	:	10/28/2020

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