Healthcare Provider Details

I. General information

NPI: 1730344094
Provider Name (Legal Business Name): TYLER J DUBS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 JOHN MADDOX DR NW SUITE A-2
ROME GA
30165-1431
US

IV. Provider business mailing address

100 JOHN MADDOX DR NW SUITE A-2
ROME GA
30165-1431
US

V. Phone/Fax

Practice location:
  • Phone: 706-295-1184
  • Fax: 706-236-1919
Mailing address:
  • Phone: 706-295-1184
  • Fax: 706-236-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number68147
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: