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Individual

MR. TYLER HENRY WOOTEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
590 NANCY ST NW, MARIETTA, GA 30060-1334
(770) 423-0395
(770) 499-0325
Mailing address
805 SANDY PLAINS ROAD, MEDICAL STAFF SERVICES, MARIETTA, GA 30066-6340

Taxonomy

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

Other

Enumeration date
09/24/2018
Last updated
11/05/2019
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