Healthcare Provider Details

I. General information

NPI: 1760337596
Provider Name (Legal Business Name): DR. RICHARD TYLER BROCK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6935 S SWEETWATER RD
LITHIA SPRINGS GA
30122-2465
US

IV. Provider business mailing address

6935 S SWEETWATER RD
LITHIA SPRINGS GA
30122-2465
US

V. Phone/Fax

Practice location:
  • Phone: 770-944-8520
  • Fax: 770-948-5949
Mailing address:
  • Phone: 770-944-8520
  • Fax: 770-948-5949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH035651
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: