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General NPI Number Information
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NPI Number | 1821389842
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Entity Type | Individual
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Provider Name | MR. TIMOTHY PATRICK RYAN JR.
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Gender | Male
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Dates
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Enumeration Date | 04/25/2011
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Last Update Date | 01/07/2016
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Provider Practice Location Address
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Address Line | 1365A CLIFTON RD NE SUITE 2300
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City | ATLANTA
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State | GA
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Zip | 30322-1013
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Country | US
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Telephone | 404-778-3381
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Fax |
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Provider Business Mailing Address
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Address Line | 2089 DUNWOODY ST NE
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City | ATLANTA
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State | GA
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Zip | 30317-1242
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Country | US
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Telephone | 703-470-7673
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 004885
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License Number State | GA
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