Healthcare Provider Details

I. General information

NPI: 1326470642
Provider Name (Legal Business Name): GREGORY TYLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2013
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 CARVER RD
GRIFFIN GA
30224-3937
US

IV. Provider business mailing address

625 CARVER RD
GRIFFIN GA
30224-3937
US

V. Phone/Fax

Practice location:
  • Phone: 770-227-9222
  • Fax: 770-227-9009
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: