Healthcare Provider Details

I. General information

NPI: 1649956095
Provider Name (Legal Business Name): TYLER MINETOLA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 MERIDIAN MARK RD STE 390
SANDY SPRINGS GA
30342-4755
US

IV. Provider business mailing address

4101 CHARLOTTE AVE STE F185
NASHVILLE TN
37209-4066
US

V. Phone/Fax

Practice location:
  • Phone: 404-237-3668
  • Fax: 404-237-9562
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD305089
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD305089
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: