Provider Demographics
NPI:1013598606
Name:DOZIER, TYRONE GREGORY JR (ATC)
Entity Type:Individual
Prefix:
First Name:TYRONE
Middle Name:GREGORY
Last Name:DOZIER
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 DREYFUS RD
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-9616
Mailing Address - Country:US
Mailing Address - Phone:402-604-0395
Mailing Address - Fax:
Practice Address - Street 1:171 N KEENELAND DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8687
Practice Address - Country:US
Practice Address - Phone:859-575-1888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT1604207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine