Provider Demographics
NPI:1689474892
Name:THREAT, TYRIVIA
Entity type:Individual
Prefix:MRS
First Name:TYRIVIA
Middle Name:
Last Name:THREAT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4437 GROVE DR NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-6619
Mailing Address - Country:US
Mailing Address - Phone:404-316-7083
Mailing Address - Fax:
Practice Address - Street 1:4437 GROVE DR NW
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-6619
Practice Address - Country:US
Practice Address - Phone:404-316-7083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor