Individual
TY IMLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1830 PINEY GROVE RD, LOGANVILLE, GA 30052-3613
(678) 618-3281
Mailing address
1830 PINEY GROVE RD, LOGANVILLE, GA 30052-3613
(678) 618-3281
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
12/02/2019
Last updated
12/02/2019
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