MEDICARE: MICHAEL TYLER LAND MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	92380	GA

General Provider Information

NPI Number	:	1184186033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL TYLER LAND MD

Provider Business Mailing Address
First Line	:	420 E 2ND AVE STE 103
Second Line	:
City	:	ROME
State	:	GA
Zip	:	30161-3210
Country	:	US
Telephone Number	:	706-509-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	6000 JOE FRANK HARRIS PKWY NW
Second Line	:
City	:	ADAIRSVILLE
State	:	GA
Zip	:	30103-2443
Country	:	US
Telephone Number	:	770-773-1534
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2019
Last Update Date	:	03/10/2023

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