Provider Demographics
NPI:1477957116
Name:TRIA, LILIA (AA)
Entity Type:Individual
Prefix:
First Name:LILIA
Middle Name:
Last Name:TRIA
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:LILIA
Other - Middle Name:
Other - Last Name:DELTCHEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AA
Mailing Address - Street 1:PO BOX 1076
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-1076
Mailing Address - Country:US
Mailing Address - Phone:770-532-7179
Mailing Address - Fax:770-534-1312
Practice Address - Street 1:743 SPRING ST NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3715
Practice Address - Country:US
Practice Address - Phone:770-532-7179
Practice Address - Fax:770-534-1312
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007328367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant