Provider Demographics
NPI:1093366940
Name:NEFF, GARY TYLER (RBT)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:TYLER
Last Name:NEFF
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 HOWELL FERRY RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3186
Mailing Address - Country:US
Mailing Address - Phone:770-373-5822
Mailing Address - Fax:
Practice Address - Street 1:3655 HOWELL FERRY RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3186
Practice Address - Country:US
Practice Address - Phone:770-373-5822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILRBT-19-98556156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-19-98556OtherBACB