Provider Demographics
NPI:1790475176
Name:BRIGGS-ROBERTS, TYLER
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:BRIGGS-ROBERTS
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 1:3355 MCDANIEL RD APT 6102
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8634
Mailing Address - Country:US
Mailing Address - Phone:770-743-6006
Mailing Address - Fax:
Practice Address - Street 1:3355 MCDANIEL RD APT 6102
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8634
Practice Address - Country:US
Practice Address - Phone:770-743-6006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056870133106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician