Individual
FAYETTA TYRA-BROOKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4351 HAMPTON MILL PKWY, DOUGLASVILLE, GA 30135-4180
(404) 660-9273
Mailing address
4351 HAMPTON MILL PKWY, DOUGLASVILLE, GA 30135-4180
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
04/27/2022
Last updated
04/27/2022
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