Provider Demographics
NPI:1174966287
Name:ROTHMAN, MICHAEL TYLER (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TYLER
Last Name:ROTHMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1549 CLAIRMONT RD.
Mailing Address - Street 2:SUITE 108
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-4636
Mailing Address - Country:US
Mailing Address - Phone:404-626-6084
Mailing Address - Fax:
Practice Address - Street 1:1549 CLAIRMONT RD
Practice Address - Street 2:SUITE 108
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4639
Practice Address - Country:US
Practice Address - Phone:404-626-6084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003663103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical