Provider Demographics
NPI:1952929150
Name:THREAT, YOLANDA P (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:P
Last Name:THREAT
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6994 HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30656-6100
Mailing Address - Country:US
Mailing Address - Phone:678-223-5519
Mailing Address - Fax:678-878-4636
Practice Address - Street 1:478 NORTHDALE RD STE 201
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8902
Practice Address - Country:US
Practice Address - Phone:770-299-1378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN094434163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology