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General NPI Number Information
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NPI Number | 1457043309
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Entity Type | Individual
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Provider Name | ALEXIS TYLER
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Gender | Female
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 311 GWINNETT DR STE 250
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-5671
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Country | US
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Telephone | 770-910-9196
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Fax |
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Provider Business Mailing Address
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Address Line | 232 SIDNEY LANIER AVE
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City | ATHENS
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State | GA
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Zip | 30607-6550
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Country | US
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Telephone | 410-259-8599
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN286244
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License Number State | GA
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