Individual
MR. TYLER ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
116 SOUTH MILL CREEK COURT, WOODSTOCK, GA 30188
(678) 349-4071
Mailing address
116 SOUTH MILL CREEK COURT, WOODSTOCK, GA 30188
(678) 349-4071
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
GA
Other
Enumeration date
03/20/2020
Last updated
03/20/2020
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