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General NPI Number Information
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NPI Number | 1891685152
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Entity Type | Individual
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Provider Name | WILLIE TYLER
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Gender | Male
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 5555 ROSWELL RD # APTW12
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City | ATLANTA
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State | GA
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Zip | 30342-5814
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Country | US
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Telephone | 470-602-1966
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Fax |
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Provider Business Mailing Address
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Address Line | 5555 ROSWELL RD # APTW12
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City | ATLANTA
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State | GA
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Zip | 30342-5814
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Country | US
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Telephone | 470-602-1966
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number |
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State | GA
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Taxonomy #7
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State | GA
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Taxonomy #8
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State | GA
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Taxonomy #9
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number |
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License Number State | GA
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