Healthcare Provider Details

I. General information

NPI: 1538516406
Provider Name (Legal Business Name): TYLER GREGORY BARTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 CIRCLE DR
COLUMBIA TN
38401-4430
US

IV. Provider business mailing address

800 ACADEMY LN
COLUMBIA TN
38401-6428
US

V. Phone/Fax

Practice location:
  • Phone: 931-490-1480
  • Fax: 931-490-1482
Mailing address:
  • Phone: 815-601-3472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: