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Individual

TYLER JAY DENMEADE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
600 PROFESSIONAL DR STE 120, LAWRENCEVILLE, GA 30046-7638
(770) 740-1860
(678) 347-2104
Mailing address
925 N POINT PKWY STE 130, ALPHARETTA, GA 30005-5211
(770) 740-1860
(678) 347-2104

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
008969
GA

Other

Enumeration date
09/20/2018
Last updated
09/20/2018
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