Healthcare Provider Details

I. General information

NPI: 1225953656
Provider Name (Legal Business Name): DR. TYLER JAMIL DOCTRIE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2498 CUMBERLAND PKWY SE
ATLANTA GA
30339-4502
US

IV. Provider business mailing address

2200 MARIETTA BLVD NW APT 715
ATLANTA GA
30318-2097
US

V. Phone/Fax

Practice location:
  • Phone: 770-432-1533
  • Fax:
Mailing address:
  • Phone: 770-432-1533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH036428
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: