Provider Demographics
NPI:1174483689
Name:SCOTT, TYREK S
Entity type:Individual
Prefix:MR
First Name:TYREK
Middle Name:S
Last Name:SCOTT
Suffix:
Gender:X
Credentials:
Other - Prefix:MRS
Other - First Name:VICTORIA
Other - Middle Name:A
Other - Last Name:BURLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CEO
Mailing Address - Street 1:212 GREEN MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30434
Mailing Address - Country:US
Mailing Address - Phone:478-206-5172
Mailing Address - Fax:
Practice Address - Street 1:212 GREEN MEADOWS CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:GA
Practice Address - Zip Code:30434
Practice Address - Country:US
Practice Address - Phone:478-206-5172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-17
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care