Provider Demographics
NPI:1376934091
Name:TYLER, JAMAR KINTE
Entity Type:Individual
Prefix:MR
First Name:JAMAR
Middle Name:KINTE
Last Name:TYLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 N MCDONOUGH ST STE 206
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-3675
Mailing Address - Country:US
Mailing Address - Phone:678-310-3286
Mailing Address - Fax:678-281-0567
Practice Address - Street 1:124 N MCDONOUGH ST STE 206
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3675
Practice Address - Country:US
Practice Address - Phone:678-310-3286
Practice Address - Fax:678-281-0567
Is Sole Proprietor?:No
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA46-1696393OtherEIN