Individual
MRS. TYRIVIA THREAT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4437 GROVE DR NW, ACWORTH, GA 30101-6619
(404) 316-7083
Mailing address
4437 GROVE DR NW, ACWORTH, GA 30101-6619
(404) 316-7083
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
03/17/2025
Last updated
03/17/2025
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