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General NPI Number Information
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NPI Number | 1164996104
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Entity Type | Individual
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Provider Name | TYLER RUSSELL PURVIS MD
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Gender | Male
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Dates
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Enumeration Date | 01/13/2019
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 110 KELLWOOD DR STE 220A
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City | PERRY
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State | GA
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Zip | 31069-3263
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Country | US
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Telephone | 478-300-7020
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Fax | 478-395-5221
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Provider Business Mailing Address
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Address Line | 110 KELLWOOD DR STE 220A
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City | PERRY
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State | GA
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Zip | 31069-3263
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Country | US
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Telephone | 478-300-7020
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Fax | 478-395-5221
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 92587
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License Number State | GA
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