Individual
MR. TYLER STEPHEN LOWE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
5774 FONTANA RD, VALDOSTA, GA 31601-2481
(478) 595-3858
Mailing address
5774 FONTANA RD, VALDOSTA, GA 31601-2481
(478) 595-3858
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT003734
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AT003734
GEORGIA SECRETARY OF STATE
GA
Enumeration date
05/05/2021
Last updated
05/05/2021
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