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General NPI Number Information
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NPI Number | 1245856608
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Entity Type | Individual
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Provider Name | MR. WILLIAM TODD TYLER
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Gender | Male
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Dates
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Enumeration Date | 06/22/2020
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Last Update Date | 06/22/2020
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Provider Practice Location Address
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Address Line | 250 E MAIN ST STE 202A
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City | CANTON
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State | GA
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Zip | 30114-2781
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Country | US
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Telephone | 678-880-9128
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Fax | 770-213-3472
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Provider Business Mailing Address
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Address Line | 250 E MAIN ST STE 202A
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City | CANTON
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State | GA
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Zip | 30114-2781
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Country | US
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Telephone | 678-880-9128
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Fax | 770-213-3472
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | PHCP010396
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License Number State | GA
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