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General NPI Number Information
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NPI Number | 1538335369
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Entity Type | Individual
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Provider Name | MARY ALLISON ROENSCH TYLER MD
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Gender | Female
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 11/03/2016
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Provider Practice Location Address
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Address Line | 2377 LENORA CHURCH RD
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City | SNELLVILLE
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State | GA
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Zip | 30078-3232
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Country | US
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Telephone | 770-979-2020
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Fax | 770-978-3321
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Provider Business Mailing Address
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Address Line | 2377 LENORA CHURCH RD
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City | SNELLVILLE
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State | GA
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Zip | 30078-3232
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Country | US
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Telephone | 770-979-2020
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Fax | 770-978-3321
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | BP10031491
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 066312
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 66312
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License Number State | GA
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