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General NPI Number Information
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NPI Number | 1124149893
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Entity Type | Individual
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Provider Name | JINI F. P. TYLER LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 07/01/2009
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Provider Practice Location Address
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Address Line | 997 COMMERCE DR SW SUITE 3A
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City | CONYERS
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State | GA
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Zip | 30094-6647
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Country | US
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Telephone | 770-361-8822
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Fax |
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Provider Business Mailing Address
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Address Line | 586 RIBBON LN
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City | CONYERS
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State | GA
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Zip | 30094-4190
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Country | US
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Telephone | 770-760-1085
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW003753
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License Number State | GA
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