Provider Demographics
NPI:1912629734
Name:ROWE, TYNERIA (SPECIALIST)
Entity Type:Individual
Prefix:
First Name:TYNERIA
Middle Name:
Last Name:ROWE
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 SPALDING DR STE SALON
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-4279
Mailing Address - Country:US
Mailing Address - Phone:678-751-9853
Mailing Address - Fax:
Practice Address - Street 1:300 COLONIAL CENTER PKWY STE 100N
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4892
Practice Address - Country:US
Practice Address - Phone:678-405-9363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty