Provider Demographics
NPI:1083067003
Name:OLIVER, TYRONE V (MA)
Entity Type:Individual
Prefix:
First Name:TYRONE
Middle Name:
Last Name:OLIVER
Suffix:V
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4665 OAKLEIGH MANOR DR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-4937
Mailing Address - Country:US
Mailing Address - Phone:404-840-5904
Mailing Address - Fax:708-613-9661
Practice Address - Street 1:2777 JEFFERSON ST
Practice Address - Street 2:SUITE 6 AND 8
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-4054
Practice Address - Country:US
Practice Address - Phone:404-840-5904
Practice Address - Fax:708-613-9661
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004472101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional